Cases from the osler medical service at Johns Hopkins University.
PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). Magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3). What is the diagnosis?
Sara E
SE
Cosgrove
D000328:Adult; D000900:Anti-Bacterial Agents; D001021:Aortic Valve / Q000382:microbiology / Q000503:physiopathology; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy; D015142:Baltimore; D002544:Cerebral Infarction / Q000175:diagnosis*; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D012720:Severity of Illness Index; D013159:Splenic Infarction / Q000150:complications / Q000175:diagnosis*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents