IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES Classical Skin Lesions Resembling Infective Endocarditis in a Patient with an Infected Aortic Composite Graft Andreas Martin Bloch1,2, Claudia Schrag1, Edith Faessler1, and Gian-Reto Kleger1 1 Medical Intensive Care Unit, Hospital of St. Gallen, St. Gallen, Switzerland; and 2Cardiovascular and Thoracic ICU, Auckland City Hospital, Auckland, New Zealand
Figure 1. Conjunctival petechiae resemble microemboli or vasculitis.
Figure 2. Osler’s node: painful, palpable, erythematous lesion.
A 58-year-old man with a history of an aortic composite graft for severe aortic regurgitation and a dilated aorta ascendens was admitted to our intensive care unit with septic shock and multiorgan failure. On clinical examination the source of his infection became apparent because he showed the classical skin findings of an infective endocarditis: conjunctival petechiae, Osler’s nodes (1) and splinter hemorrhages. Interestingly, there were no vegetations identified on transesophageal echocardiography examination. However, on a computed tomography scan an abscess formation around the aortic composite graft was evident. Despite prompt antibiotic treatment and referral for emergent cardiac surgery he died a few days later as a result of a subarachnoid hemorrhage. Conjunctival petechiae, Osler’s nodes, and splinter hemorrhages represent vascular phenomena caused by endovascular infection, most commonly acute infective endocarditis. These findings can also rarely be seen in other endovascular infections such as aortic graft infections (2). n Author disclosures are available with the text of this article at www.atsjournals.org.
Am J Respir Crit Care Med Vol 189, Iss 10, pp e66–e67, May 15, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201304-0635IM Internet address: www.atsjournals.org
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American Journal of Respiratory and Critical Care Medicine Volume 189 Number 10 | May 15 2014
IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES
Figure 3. Osler’s nodes are caused by immune complex depositions.
References
Figure 4. Splinter hemorrhage (index finger) caused by microemboli.
2. Tanaka A, Sakamoto T, Okada K, Okita Y. Vegetation attached to the elephant trunk. Eur J Cardiothorac Surg 2013;44:565–566.
1. Farrior JB, Silverman ME. A consideration of the differences between a Janeway’s lesion and an Osler’s node in infectious endocarditis. Chest 1976;70:239–243.
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences
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Figure 1. Conjunctival petechiae resemble microemboli or vasculitis.
Figure 2. Osler’s node: painful, palpable, erythematous lesion.
A 58-year-old man with a history of an aortic composite graft for severe aortic regurgitation and a dilated aorta ascendens was admitted to our intensive care unit with septic shock and multiorgan failure. On clinical examination the source of his infection became apparent because he showed the classical skin findings of an infective endocarditis: conjunctival petechiae, Osler’s nodes (1) and splinter hemorrhages. Interestingly, there were no vegetations identified on transesophageal echocardiography examination. However, on a computed tomography scan an abscess formation around the aortic composite graft was evident. Despite prompt antibiotic treatment and referral for emergent cardiac surgery he died a few days later as a result of a subarachnoid hemorrhage. Conjunctival petechiae, Osler’s nodes, and splinter hemorrhages represent vascular phenomena caused by endovascular infection, most commonly acute infective endocarditis. These findings can also rarely be seen in other endovascular infections such as aortic graft infections (2). n Author disclosures are available with the text of this article at www.atsjournals.org.
Am J Respir Crit Care Med Vol 189, Iss 10, pp e66–e67, May 15, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201304-0635IM Internet address: www.atsjournals.org
e66
American Journal of Respiratory and Critical Care Medicine Volume 189 Number 10 | May 15 2014
IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES
Figure 3. Osler’s nodes are caused by immune complex depositions.
References
Figure 4. Splinter hemorrhage (index finger) caused by microemboli.
2. Tanaka A, Sakamoto T, Okada K, Okita Y. Vegetation attached to the elephant trunk. Eur J Cardiothorac Surg 2013;44:565–566.
1. Farrior JB, Silverman ME. A consideration of the differences between a Janeway’s lesion and an Osler’s node in infectious endocarditis. Chest 1976;70:239–243.
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences
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