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Acute onset of petechia/ ecchymosis - NOT Infectious Endocarditis

Discussion in 'Spot Diagnosis' started by Mdhardcorez, Mar 6, 2014.

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  1. Mdhardcorez

    Mdhardcorez Famous Member

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    NOTE: There is update on the labs and studies. See the updates and see what you think now.

    This is a 54yr old Caucasian male w PMH of HTN and HLD presents to hospital due to acute onset of 'weird' rash on his extremities. No constitutional symptoms of any kind. Similar rash was reported by pt about 1yr, which resolved after a round of abx.

    He was told to possibly have 'murmur' on auscultation outside of hospital. No hx of drug use, smoking or ETOH.

    In addition, he was found to have AKI without hx of renal insufficiency. CRE 0.9 --> 2.5. Otherwise, CBC/ CMP within NL range. 2D echo ordered. BCx pending.

    What else would you still order? And what do you think this is?

    image.jpg image.jpg image.jpg image.jpg

    Post your comments and thoughts.

    I'll provide more clinical information in 3days including lab results and diagnostic reports.

    Final diagnosis will be posted in 1wk following all discussions.

    Have fun and let's save this pt

    ------------------- update ------------------
    2D echo (-)
    TEE (-)
    BCx (-)
    CRE 3.2
    Skin biopsy - leukoclastic vasculitis.
    Still no fever/chills; rash disappeared on hands while ecchymosis in foot persisted. And no new rash noted. Pt is on abx currently and his HTN medx only.

    What do you think now? Are you still thinking IE? Or is there anything else?

    Read more at: http://forum.facmedicine.com/threads/acute-onset-of-petechia-ecchymosis.18032/page-2
    Answer will be posted in 3days.


    Hidden Content:
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    Last edited: Mar 13, 2014
    Mdhardcorez, Mar 6, 2014
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  2. Nana Shonk

    Nana Shonk Bronze Member

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    Janeway lesions - vascular sign of infective endocarditis
     

    Nana Shonk, Mar 6, 2014
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  3. Milovan Nikolic

    Milovan Nikolic Famous Member

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    Janeway lesions - vascular sign of infective endocarditis
     

    Milovan Nikolic, Mar 6, 2014
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  4. SophieEsther

    SophieEsther Famous Member

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    IE
     

    SophieEsther, Mar 6, 2014
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    Ekundayo Well-Known Member

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    Janeway lesions.... possible Infective Endocarditis
     

    Ekundayo, Mar 6, 2014
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  6. indra

    indra Bronze Member

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    Kagak tau
     

    indra, Mar 6, 2014
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    Fadel R.Bacha Famous Member

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    Janeway Lesions indicative of infective Endocarditis
     

    Fadel R.Bacha, Mar 6, 2014
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    Palmar erytheme, opo jhal?
     

    Arif Rahman SKed, Mar 6, 2014
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    Lims, Mar 6, 2014
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    immune-related deposits: vasculitis
     

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    amer fetyan, Mar 6, 2014
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    H-azad Bronze Member

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    H-azad, Mar 6, 2014
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    Yvette, Mar 6, 2014
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    MilosDjurin Famous Member

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    endocarditis, hemoculture, ehocardiogram...
     

    MilosDjurin, Mar 6, 2014
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    Xosh Famous Member

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    infective endocarditis
     

    Xosh, Mar 6, 2014
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    Amany Doraidy Famous Member

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    infective endocarditis
     

    Amany Doraidy, Mar 6, 2014
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  19. badal

    badal Famous Member

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    /
     

    badal, Mar 6, 2014
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    Willington Famous Member

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    Lesiones de Janeway (signo vascular de la endocarditis infecciosa)
     

    Willington, Mar 6, 2014
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