Thursday, March 12, 2009

The Sluggish Doc

A 65 yo female physician has noted increasing fatigue and malaise for the past 1-2 months. When she takes her temperature, she is suprised to find that it is 100.6 degree F. She also notes some new lesions on her arms and nails. However, she is too busy to see her own physician. What finally brings her to medical attention is the development of red, painful swelling on her dorsum of her left foot. Her physician notes Roth spots in both eyes and a loud mitral insufficiency murmur. Of note, she has a longstanding history of mitral valve prolapse.

Multiple blood cultures grow Strep viridans. Her lab studies reveal a positive rheumatoid factor test. Despite antibiotic, she develops refractory heart failure and requires mitral valve replacement.

Diagnosis: Subacute Infective Endocarditis



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