BLOCKING A RASH DIAGNOSIS: AN UNUSUAL CASE OF INFECTIVE ENDOCARDITIS

• Type of Material: Article
• Authors: Brittne Halford, Emory University; Mariah M Barstow, Emory University; Haley Berka, Emory University; Caitlin Taylor, Emory University
• Language: English
• Date: 2018-04-01
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © BMJ Publishing Group Limited 2019.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bcr-2018-226213
• Title of Journal or Parent Work: JOURNAL OF GENERAL INTERNAL MEDICINE
• Volume: 33
• Issue: 3
• Start Page: S474
• End Page: S475
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors
• Keywords: Health Care Sciences & Services; General & Internal Medicine; Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

We report a case of a previously healthy, afebrile patient who presented with subacute bilateral lower extremity rash and complete heart block, which was later found to be secondary to infective endocarditis. His transoesophageal echocardiogram detected multiple vegetations and blood cultures were positive for Granulicatella adiacens, a nutritionally variant streptococcus that is a normal component of oral flora and thought to be responsible for approximately 5% of all cases of streptococcal endocarditis. Due to concerns for renal failure, the patient was treated with an unconventional regimen of ampicillin and ceftriaxone. He underwent a valve replacement and pacemaker placement and has done well since hospital discharge.