A 40-year-old man presented with a 10-day history of fever (>38.5°C) and skin lesions. He had been referred for acute type A aortic dissection and had undergone a Bentall procedure with aortic valve replacement using a mechanical prosthetic valve six months ago. Transthoracic and transesophageal echocardiogram showed aortic valve vegetations. Additionally abnormal activity around the site of prosthetic valve implantation was detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Repeated peripheral blood cultures showed the presence of Alcaligenes faecalis. The diagnosis of prosthetic valve endocarditis (PVE) was established (1).
Splinter hemorrhages [Fig. 1- (arrow)] that are defined as tiny bleeding points in the nails are not a specific sign for the diagnosis of infective endocarditis (IE). Conversely, vascular phenomena such as Janeway lesions (Fig. 2-4), and immunological phenomena, such as Osler’s nodes [Fig. 3, 4 (arrows)], although minor criteria for the diagnosis of IE, are important clinical features and can help to establish the diagnosis, particularly for PVE, which is still associated with difficulties in diagnosis.
Figure 1.
Splinter hemorrhages
Figure 2.
Janeway lesions
Figure 4.
Janeway’ lesions and Osler’s nodes
Figure 3.
Janeway’ lesions and Osler’s nodes
References
- 1.Aisenberg G, Rolston K, Safdar A. Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003) Cancer. 2004;101:2134–40. doi: 10.1002/cncr.20604. [DOI] [PubMed] [Google Scholar]