On physical examination, peripheral signs were noted, including petechiae, Osler’s nodes, splinter hemorrhages, and Janeway lesions (Figure), suggestive of infective endocarditis,1 although no murmur was heard on cardiac auscultation. The patient was alert but lethargic her temperature was 38.6℃ and her pulse was 101 beats/min.
The patient had a history of diabetes and hypertension, and had undergone ureteral stenting for obstructive pyelonephritis 2 months earlier. This review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.Ī 70-year-old woman presented with a 9-day history of fever and appetite loss (both of which were of unknown etiology), unresponsive to antibiotics and fluids.
#Osler nodes skin#
DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient's life) DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU) DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin and DMs previously present in the patient and unrelated to the critical process. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. Despite this, dermatological manifestations (DMs) are relatively frequent in critically ill patients. These findings can also rarely be seen in other endovascular infections such as aortic graft infections ( 2).Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients.
Despite prompt antibiotic treatment and referral for emergent cardiac surgery he died a few days later as a result of a subarachnoid hemorrhage.Ĭonjunctival petechiae, Osler’s nodes, and splinter hemorrhages represent vascular phenomena caused by endovascular infection, most commonly acute infective endocarditis. However, on a computed tomography scan an abscess formation around the aortic composite graft was evident. Interestingly, there were no vegetations identified on transesophageal echocardiography examination. On clinical examination the source of his infection became apparent because he showed the classical skin findings of an infective endocarditis: conjunctival petechiae, Osler’s nodes ( 1) and splinter hemorrhages. A 58-year-old man with a history of an aortic composite graft for severe aortic regurgitation and a dilated aorta ascendens was admitted to our intensive care unit with septic shock and multiorgan failure.