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  #1  
Old 09-03-2012
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Heart Which type of Infective Endocarditis?

A 16yr old male is taken by parents to their family physician for evaluation of rash....his mother complains her child developed a red butterfly rash over face associated with fever and chills since 10 days..his other symptoms include nausea, vomiting, lymphadenopathy at neck region..he had presented earlier with similar history in the past which was associated with necrotic regions over palms and rash over flexures and with dark urine....on further examination doctor finds a murmur in mitral valve area on auscultation...which of the following endocarditis can be preferably associated with this patient..?
a) acute infective endocarditis
b) subacute infective endocarditis
c) marantic endocarditis
d) libman sacks endocarditis
e) none.

please leave your diagnosis too...

i'm not sure with the answer though.......

Last edited by venky2600; 09-03-2012 at 12:55 AM.
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Old 09-03-2012
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Default You made be think

The moment i saw butterfly rash
I thought
Dx- SLE
endocarditis: Libman-sacks

but if that would be answer. Why would you post this question (as most of us know this right)

Then there is one more symptom which not typical to SLE
Necrotic region over palm and rash over flexure.
so confuse- Just a random guess
C. marantic endocarditis or non bacterial endocarditis. (as this disease doesn't seems infectious)
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Old 09-03-2012
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Default my answer :)

Hmm...nice question... hard though

I think I'll go with A) acute infective endocarditis

Butterfly rash is a buzzword for SLE but taking the pt's age and gender (and the fact that on usmle they should present 'a typical case/patient') I'll exclude D.

Actually butterfly rash appears also in rosacea, scarlet fever, dermatomyositis, and pellagra.
And I think that maybe rebout of rheumatic fever is a diagnosis here...

as for B - subacute endocarditis - I guess it's usually in pts with damaged valve... - but not 100% sure here...

as for C (NBTE)- I think it's usually not accompanied by a fever, unless of course there's some other underlying disease with fever but if so it would be just impossible to distinguish it from infective endocarditis based on the symptoms presented. I think that if it was NBTE more typical presentation would be focused on thromboembolic symptoms...

I'm very curious about the answer
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Old 09-03-2012
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Quote:
Originally Posted by venky2600 View Post
Q) a 16yr old male is taken by parents to their family physician for evaluation of rash....his mother complains her child developed a red butterfly rash over face associated with fever and chills since 10 days..his other symptoms include nausea,vomiting,lymphadenopathy at neck region,malaise,joint pains,splinter hemorrhage,painful lesions over hands and feet,mild leukocytosis..he had presented earlier with similar history in the past which was associated with necrotic regions over palms and rash over flexures and associated with sore throat, dark urine.but, treated spontaneously without any treatment.his grandfather too died with the same history but without any proper diagnosis but his father is normal though.....on further examination doctor finds a murmur in mitral valve area on auscultation...which of the following endocarditis can be preferably associated with this patient..?
a) acute infective endocarditis
b) subacute infective endocarditis
c) marantic endocarditis
d) libman sacks endocarditis
e) none.

please leave your diagnosis too...

i'm not sure with the answer though.......
sorry guys for not mentioning enough descriptive symptoms prior
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  #5  
Old 09-03-2012
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Embarrassed

Quote:
Originally Posted by koolkiller88; casandra View Post
The moment i saw butterfly rash
I thought
Dx- SLE
endocarditis: Libman-sacks

but if that would be answer. Why would you post this question (as most of us know this right)

Then there is one more symptom which not typical to SLE
Necrotic region over palm and rash over flexure.
so confuse- Just a random guess
C. marantic endocarditis or non bacterial endocarditis. (as this disease doesn't seems infectious)
Hmm...nice question... hard though

I think I'll go with A) acute infective endocarditis

Butterfly rash is a buzzword for SLE but taking the pt's age and gender (and the fact that on usmle they should present 'a typical case/patient') I'll exclude D.

Actually butterfly rash appears also in rosacea, scarlet fever, dermatomyositis, and pellagra.
And I think that maybe rebout of rheumatic fever is a diagnosis here...

as for B - subacute endocarditis - I guess it's usually in pts with damaged valve... - but not 100% sure here...

as for C (NBTE)- I think it's usually not accompanied by a fever, unless of course there's some other underlying disease with fever but if so it would be just impossible to distinguish it from infective endocarditis based on the symptoms presented. I think that if it was NBTE more typical presentation would be focused on thromboembolic symptoms...

I'm very curious about the answer :sorry:
apology for delay :sorry:
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  #6  
Old 09-03-2012
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Default

Quote:
Originally Posted by venky2600 View Post
sorry guys for not mentioning enough descriptive symptoms prior
those bold new info were kinda important...
so what's the answer??
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Old 09-03-2012
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Originally Posted by venky2600 View Post
apology for delay :sorry:
don't apologize, post the answer
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  #8  
Old 09-03-2012
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Originally Posted by venky2600 View Post
sorry guys for not mentioning enough descriptive symptoms prior
Due to his prior history i would go with
B. Subacute infective endocarditis due to strep. viribans
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Originally Posted by koolkiller88 View Post
Due to his prior history i would go with
B. Subacute infective endocarditis due to strep. viribans
so you think he had a murmur (valve damage) on his previous bouts?

but you think that with Strep. viridans he would have had cervical lymphadenopathy?

I'm sticking to A and my previous explanation.

I'm really really anxious now for the answer from venky2600

Last edited by Casandra; 09-03-2012 at 02:54 AM.
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the most appropriate answer is A) acute infective endocarditis

the patient has rheumatic heart disease leading to mitral valve murmur...though rheumatic endocarditis is seperate entity from various types of endocarditis..it's kinda acute endocarditis
it's not subacute since no previously damaged valve has been notified

the patient is suffering from strep A pyogenes.....causing erysipelas---erysipelas signifies with red butterfly shaped rash on the face(as mentioned in kaplan micro text)..associated with fever,chills,nausea,vomiting,lymphadenopathy...... .
earlier the pt. had strep pharyngeal infection which lead to glomerulonephritis(dark urine)..for which he hasn't been treated....with repeated exposure to the infection of streptococcus pyogenes rheumatic heart disease can be seen along with infective endocarditis.....
rheumatic heart disease can be autoimmune in most cases..

but, i'm stuck between option A and E..... but the explanation didn't give anything for none...actually i changed some format of question for understanding ..the question is from rapid review pathology
could you please explain it..
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  #11  
Old 09-03-2012
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Quote:
Originally Posted by Casandra View Post
so you think he had a murmur (valve damage) on his previous bouts?

but you think that with Strep. viridans he would have had cervical lymphadenopathy?

I'm sticking to A and my previous explanation.

I'm really really anxious now for the answer from venky2600
Why steptococcus-
1. MCC of infective endocarditis
2. at previous exposure had sore throat and thats also without treatment.

not sure about cervical lymphadenopathy
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Old 09-03-2012
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Default

Quote:
Originally Posted by venky2600 View Post
the most appropriate answer is A) acute infective endocarditis

the patient has rheumatic heart disease leading to mitral valve murmur...though rheumatic endocarditis is seperate entity from various types of endocarditis..it's kinda acute endocarditis
it's not subacute since no previously damaged valve has been notified

the patient is suffering from strep A pyogenes.....causing erysipelas---erysipelas signifies with red butterfly shaped rash on the face(as mentioned in kaplan micro text)..associated with fever,chills,nausea,vomiting,lymphadenopathy...... .
earlier the pt. had strep pharyngeal infection which lead to glomerulonephritis(dark urine)..for which he hasn't been treated....with repeated exposure to the infection of streptococcus pyogenes rheumatic heart disease can be seen along with infective endocarditis.....
rheumatic heart disease can be autoimmune in most cases..

but, i'm stuck between option A and E..... but the explanation didn't give anything for none...actually i changed some format of question for understanding ..the question is from rapid review pathology
could you please explain it..
I was do thinking about erysipelas (kinda slap face but not fifth disease) but then i was thinking infective endocarditis is caused by strep pyrogen and staph aureus. Now i am confused. Tell me which strep. caused sore throat?
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  #13  
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Quote:
Originally Posted by koolkiller88 View Post
I was do thinking about erysipelas (kinda slap face but not fifth disease) but then i was thinking infective endocarditis is caused by strep pyrogen and staph aureus. Now i am confused. Tell me which strep. caused sore throat?
it's strep pyogenes the culprit for causing.....erysipelas,cellulitis,pharyngitis(stre p throat),rheumatic heart disease,glomerulo nephritis
but, it's kinda rare to cause infective endocarditis
it's strep. viridans which cause endocaritis commonly in streptococci
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