Case history
Case history
A 31-year-old woman presents with a 1-week history of fever, chills, fatigue, and unilateral ankle pain. Her past medical history includes mitral valve prolapse and hypothyroidism. She admits to infrequent intravenous heroin use and has a 10-pack-year history of smoking. Physical examination reveals temperature of 39°C (102°F), regular heart rate 110 beats per minute, blood pressure 110/70 mmHg, and respiration rate of 16 breaths per minute. Her cardiovascular examination reveals a grade 2/4 holosystolic murmur that is loudest at the right upper sternal border. Her right ankle appears red and warm, and is very painful on dorsiflexion.
Other presentations
There is a wide spectrum of presentations, which are often dependent on the organism responsible as well as any underlying risk factors. Acute IE can present with septic embolic phenomenon such as stroke, septic joint, or splenic infarct accompanied by fever and cardiac murmur. Subacute IE may be associated primarily with constitutional symptoms such as fever, malaise, weakness, and peripheral stigmata such as embolic phenomenon, Osler nodes, Janeway lesions, or splinter haemorrhages.
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