A Male with Chills and Arthralgias

The Medicine Forum

Ojha, MD, Ambrish¹  Chiang, MD, Lo-Ku¹ 

[1] Thomas Jefferson University HospitalThomas Jefferson University HospitalThomas Jefferson University Hospital

关键词: A Male;    Chills;    Arthralgias;    thomas jefferson university hospital;    internal medicine;    infectious diseases;   

DOI  :  

学科分类：医学（综合）

来源: Thomas Jefferson University

【 摘 要 】

A 53-year old man presented to the ED with complaintsof fevers and chills for 5 days. Two days prior, he startedhaving generalized arthralgias and a painfully numb leftindex finger. Similar symptoms had also begun on hisleft great toe (See Figures D and E, Color Plates page19). The patient denied recent trauma, although he wasunsure if he had sustained an insect bite on the dorsalaspect of his left hand 8 hours prior to the onset ofsymptoms. Three sets of blood cultures obtained priorto admission were positive for methacillin-sensitiveStaphylococcus aureus. The patient was treated withintravenous nafcillin and gentamicin. A transesophagealechocardiography was performed, which showed a friableand perforated left coronary cusp of the aortic valve,resulting in severe aortic insufficiency. The patient wasscheduled for emergent aortic valve replacement. It wassurmised that the initial site of infection was a badlyulcerated blister located on the patient’s right great toe.

【 授权许可】

Unknown