Extract

A 69-year-old male presented with a 3-week history of fatigue. Physical examination revealed an Osler's node on the right index finger (see SupplementarySupplementary Data), a Janeway lesion in the right palm (see SupplementarySupplementary Data), and a splinter haemorrhage in the right middle finger. Laboratory data showed leucocytosis and methicillin-resistant Staphylococcus aureus grew on blood cultures. A transthoracic echocardiogram (TTE) was normal. A brain magnetic resonance imaging (done due to intermittent confusion) revealed ring-enhancing lesions consistent with septic emboli. Abdominal computed tomographic scan performed due to abdominal pain showed a splenic infarction (see SupplementarySupplementary Data). Due to high suspicion for infective endocarditis (IE), a transoesophageal echocardiogram (TEE) was performed which showed a 1.0 × 0.6 cm mobile mass attached to the posteromedial papillary muscle (Figure 1; see SupplementarySupplementary Data) with no mitral regurgitation. All valves were visualized with no vegetations. Treatment with vancomycin and rifampicin resulted in rapid clinical improvement. Repeat TEE was not performed considering the complete resolution of symptoms.

You do not currently have access to this article.