Case 2-1997 — A 38-Year-Old Man with Digital Clubbing, Low-Grade Fever, and a Murmur

Presentation of CaseA 38-year-old schizophrenic man was admitted to the hospital because of digital clubbing and a cardiac murmur.The patient had been well until about one year earlier, when he began to have swelling of the fingers and toes. Eleven months before admission, an evaluation elsewhere showed a grade 2 systolic murmur at the lower left sternal border. One month before admission, he underwent a dental extraction and took ampicillin prophylactically for two days. On the day of admission, examination of the patient in the medical clinic revealed two loud murmurs. A cardiac ultrasonographic examination showed severe mitral . . .