Images in Clinical Medicine
Septic Peripheral Embolization from Haemophilus aphrophilus Endocarditis
N Engl J Med 2002; 347:816September 12, 2002
- Article
Figure 1 A 21-year-old, previously healthy man with excellent dentition presented with a two-week history of high-grade fever, chills, and malaise. On the fourth hospital day, an early decrescendo diastolic murmur was heard for the first time. The white-cell count was 10,600 per cubic millimeter, with 9 percent band forms. Transesophageal echocardiography revealed substantial aortic regurgitation and vegetations (arrows in Panel A) on a bicuspid aortic valve. The patient was treated with floxacillin and gentamicin before blood cultures yielded Haemophilus aphrophilus. On the eighth day, he had a red, fluctuant, painful swelling on his left foot at the metatarsal level (Panel B). Duplex ultrasonography revealed an embolus (arrows in Panel C) in a branch of the dorsalis pedis artery. The blood flow behind the embolus was unhampered (orange area in Panel C). Percutaneous puncture of the thrombus revealed the same bacteria. After emergency aortic-valve replacement and antibiotic treatment, his temperature normalized and his foot healed. LV denotes left ventricle.
J.H. Marc Groeneveld, M.D.
Julien B.C.M. Puylaert, M.D., Ph.D.
Westeinde Hospital, 2512 VA The Hague, the Netherlands- Citing Articles (1)
Citing Articles
1
Ja Young Lee, Si Hyun Kim, Haeng Soon Jeong, Seung Hwan Oh, Hye Ran Kim, Young Il Yang, Yang Haeng Lee, Jeong Nyeo Lee, Jeong Hwan Shin. (2009) Septic Peripheral Embolism in Left Leg from Aggregatibacter aphrophilus Endocarditis. Korean Journal of Clinical Microbiology 12:2, 82
CrossRef
