Changes in the extremities in Infective endocarditis
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Dear Ask The Doctor: Hi Doctor, I had a aortic valve replacement in march for endocarditis which destroyed my bicuspid (congenital valve). My recovery went well. I am on coumadinbecause I have a mechanical valve.I was on IV antibiotics for around 8wks.I went back to work and lasted only three weeks,then got pylonepritis and endocarditis and was amitted to hospital for 1week.echo looked okay. Now on iv penicillinG every 6hrs at home .My question is I have painful fingertips and toes,but no hemorragh, Is this related to the endocarditis and if so is it reversible? Thanks for your help. ps I am 45yr old female,
Dear Annemarie: There are several phenomenons that can occur in the extremities as a result of infective endocarditis (IE). These include splinter haemorrhages, Osler’s nodes, finger clubbing or arthritis. Splinter haemorrhages are linear and red haemorrhages under the nails, and usually extend for the entire length of the nail. Osler’s nodes are red to purple tender nodules that usually occur in the pulp of the fingertips and toes, and soles of the feet. They are caused by immune reaction to vasculitis (inflammation of the blood vessels). Before the nodules erupt they may be preceded by pain. The nodules last from hours to several days. They remain tender for a maximum of 2 days. Finger clubbing may occur with chronic untreated IE. This now occurs in <10% of patients and is usually painless. It manifests as loss of the normal angle between the nail bed and the finger and may extend to enlargement of the soft tissue of the fingertip with a characteristic “drumstick” appearance. Arthritis can also occur in association with IE. The arthritis is usually asymmetrical and is limited to 1-3 joints. Therefore the painful fingertips and toes are most likely related to IE and should improve as the endocarditis resolves. |
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Last Updated ( Monday, 19 July 2010 )
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