Cargando…

Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction

A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days lat...

Descripción completa

Detalles Bibliográficos
Autores principales: Degheim, George, Hiner, Evan, Berry, Abeer, Foster, Nathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086409/
https://www.ncbi.nlm.nih.gov/pubmed/32231819
http://dx.doi.org/10.1155/2020/5314503
_version_ 1783509117435904000
author Degheim, George
Hiner, Evan
Berry, Abeer
Foster, Nathan
author_facet Degheim, George
Hiner, Evan
Berry, Abeer
Foster, Nathan
author_sort Degheim, George
collection PubMed
description A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days later with a progressive rash that involved the entire left lower extremity to the level of the knee. He was diagnosed with herpes zoster (shingles) and was prescribed acyclovir and steroids. After several days, the patient presented for the third time to the ED. He developed a right lower extremity discomfort this time. The pain in bilateral lower extremities had become unbearable. His cardiac examination revealed a systolic murmur at the apex and a faint diastolic murmur at the left sternal border. Ultimately, he had an echocardiogram that demonstrated both a bicuspid aortic valve and large vegetation on the anterior leaflet of the mitral valve, and his blood culture grew Streptococcus mitis and Streptococcus oralis. The patient was subsequently diagnosed with subacute bacterial endocarditis thought to be sourced from his poor dentition. The diagnosis of infective endocarditis is often delayed due to its nonspecific clinical presentations. Our case displays an unusual skin manifestation of IE that may be present in the absence of other signs and symptoms of the disease.
format Online
Article
Text
id pubmed-7086409
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-70864092020-03-30 Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction Degheim, George Hiner, Evan Berry, Abeer Foster, Nathan Case Rep Infect Dis Case Report A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days later with a progressive rash that involved the entire left lower extremity to the level of the knee. He was diagnosed with herpes zoster (shingles) and was prescribed acyclovir and steroids. After several days, the patient presented for the third time to the ED. He developed a right lower extremity discomfort this time. The pain in bilateral lower extremities had become unbearable. His cardiac examination revealed a systolic murmur at the apex and a faint diastolic murmur at the left sternal border. Ultimately, he had an echocardiogram that demonstrated both a bicuspid aortic valve and large vegetation on the anterior leaflet of the mitral valve, and his blood culture grew Streptococcus mitis and Streptococcus oralis. The patient was subsequently diagnosed with subacute bacterial endocarditis thought to be sourced from his poor dentition. The diagnosis of infective endocarditis is often delayed due to its nonspecific clinical presentations. Our case displays an unusual skin manifestation of IE that may be present in the absence of other signs and symptoms of the disease. Hindawi 2020-03-11 /pmc/articles/PMC7086409/ /pubmed/32231819 http://dx.doi.org/10.1155/2020/5314503 Text en Copyright © 2020 George Degheim et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Degheim, George
Hiner, Evan
Berry, Abeer
Foster, Nathan
Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title_full Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title_fullStr Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title_full_unstemmed Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title_short Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction
title_sort dermatologic conundrum: a cardiac condition masqueraded as a dermatologic distraction
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086409/
https://www.ncbi.nlm.nih.gov/pubmed/32231819
http://dx.doi.org/10.1155/2020/5314503
work_keys_str_mv AT degheimgeorge dermatologicconundrumacardiacconditionmasqueradedasadermatologicdistraction
AT hinerevan dermatologicconundrumacardiacconditionmasqueradedasadermatologicdistraction
AT berryabeer dermatologicconundrumacardiacconditionmasqueradedasadermatologicdistraction
AT fosternathan dermatologicconundrumacardiacconditionmasqueradedasadermatologicdistraction