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  #1  
Old 09-19-2011
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Heart Endocarditis and peripheral embolization!

An endocarditis that is recognized by small, sterile fibrin deposits randomly arranged along the line of closure of the valve leaflets and also sterile peripheral embolization is highly possible in which of the following patients?

A) A 12-year-old girl with high fever that already had a surgical systemic to pulmonary shunts and conduits at age 2
B) A 24-year-old HIV-positive man who is IV drug abuser
C) A 58-year-old woman with systemic lupus erythematosus and three weeks of fever, soaking sweats, and negative blood cultures
D) A 24-year-old man with history of abdominal pain, Bright red flushing of the face, neck, or upper chest, wheezing and diarrhea
E) A 23-year-old woman with history of rheumatic fever and recent dental procedure
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  #2  
Old 09-19-2011
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B.iv drug abuser
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Old 09-19-2011
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C) A 58-year-old woman with systemic lupus erythematosus and three weeks of fever, soaking sweats, and negative blood cultures
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  #4  
Old 09-21-2011
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Correct Answer Answer

This is characteristic feature of non-bacterial thrombotic endocarditis (marantic endocarditis) which can cause sterile emboli.

Marantic vegetations are often associated with previous rheumatic fever.
Other risk factors include:
  • hypercoagulable states,
  • mucin-producing adenocarcinomas,
  • systemic lupus erythematosus
  • trauma (e.g., catheters).
C is correct. Actually, it was a real case of marantic endocarditis that I chose for this question:
http://www.etsu.edu/com/medicalmyste...ocarditis.aspx
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Old 09-23-2011
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Isn't libman sack endocarditis for SLE and marantic endocarditis for mucinous tumors such as pancreatic ?
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Old 09-23-2011
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I go with C. because that is the only "sterile" option. SLE libman-sachs.

2m82_ghasemi

can u please explain what is D) A 24-year-old man with history of abdominal pain, Bright red flushing of the face, neck, or upper chest, wheezing and diarrhea.
Is it 3(4)D symptoms?
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Old 09-23-2011
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@DOC SIKORSRKI:I think D is a case of carcinoid syndrome of small illeum with liver metastasis.Increase serotonin can result in flushinng,wheezing and diarrhoea.
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  #8  
Old 09-23-2011
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Answer is pointing to C..Lupus...
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Old 09-24-2011
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Quote:
Originally Posted by mohitkmc View Post
@DOC SIKORSRKI:I think D is a case of carcinoid syndrome of small illeum with liver metastasis. Increase serotonin can result in flushinng, wheezing and diarrhoea.
-------------

To Dr. DocSikorski

D is carcinoid syndrome that can cause endocarditis. In this condition the valves on the left side of the heart are rarely involved, because serotonin and other carcinoid secretory products are detoxified in the lung.

This type of endocarditis characteristically involve the mural endocardium or the valvular cusps of the right side of the heart.
--------------

Libman-Sacks endocarditis, which is small vegetations on either or both surfaces of the valve leaflets, is seen in SLE. It is a form of nonbacterial endocarditis and is one of the most common cardiac manifestations of lupus (the most common being Pericarditis).
The vegetations are small and formed from strands of fibrin, neutrophils, lymphocytes, and histiocytes. The mitral valve is typically affected.
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