Peripheral and systemic findings in subacute endocarditis
THE CONTEXT
Subacute endocarditis can produce cutaneous, digital, splenic and urinary findings that help prompt recognition of underlying heart disease.
Skin and digital findings
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Petechial haemorrhages may occur in the skin and mucous membranes, while splinter haemorrhages occur beneath fingernails or toenails.
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Osler nodes are rare, painful, tender fingertip swellings that are probably caused by vasculitis.
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Digital clubbing is a late sign.
Systemic findings and clinical significance
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The spleen is frequently palpable. Coxiella infections may cause considerable enlargement of both the spleen and liver.
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Non-visible haematuria is common.
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Any of these findings in a patient with persistent fever, raised blood inflammatory markers or malaise warrants re-examination for previously unrecognised heart disease.