Conclusions
This case describes a complicated presentation of rightsided
IE. The patient had multiple findings suggesting
the diagnosis of IE including a new systolic murmur,
cutaneous manifestations, and pulmonary infarcts. Although
the patient had no prior history of cardiac valvular
disease, the poorly maintained central venous
catheter was a strong predisposing source for cardiac infection.
An additional finding of microscopic hematuria,
noted on ED evaluation, may have been a sign of renal
infarct or glomerulonephritis, both of which are strongly
associated with IE. Approximately 24 hours after the patient
presented to the ED, blood cultures were reported
positive for oxacillin-sensitive staphylococcus. Interestingly,
without this microbiologic data, the patient did
not meet criteria for the diagnosis of IE using the traditional
Duke criteria. However, bedside EUS, performed
as part of the initial patient assessment, immediately
suggested the correct diagnosis and allowed for earlier
initiation of appropriate therapy and consultation with
the appropriate specialists.