Clinical History:

A 32-year-old housewife being treated for Hodgkin's disease developed a subcutaneous abscess at the site of an iv line and Staphylococcus aureus was isolated by culture.  Drainage and oral antibiotics resulted in healing but shortly thereafter she developed fever, night sweats, and a petechial rash on skin and mucous membranes.  Physical and laboratory examination showed a new cardiac murmur as well as microscopic hematuria and proteinuria.

Questions:

1. What test is indicated?

2. This is positive, what is your diagnosis?  If the patient died, her heart might look like Figure 1.  Describe the gross appearance.  A section of valve is seen in Figure 2 stained with a modified Gram technique.  What do you see?

3. What is the cause of the hematuria?

4. What other complications might ensue?

ANSWERS

||  Case 1  ||  Case 2  ||  Case 3  ||  Case 4 ||  Case 5 ||  Case 6  ||  Case 8  ||  Case 9  ||  Case 10  ||