Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature

Abstract Background Hereditary hemorrhagic telangiectasia, also known as Osler–Weber–Rendu disease, induces arteriovenous malformations in visceral organs. Arteriovenous malformations increase the risk of severe infections and are a common complication associated with hemorrhagic telangiectasia. How...

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Main Authors: Genki Naruse, Takatomo Watanabe, Hiroyuki Okura
Format: Article
Language:English
Published: BMC 2022-05-01
Series:Journal of Medical Case Reports
Subjects:
Online Access:https://doi.org/10.1186/s13256-022-03427-2
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author Genki Naruse
Takatomo Watanabe
Hiroyuki Okura
author_facet Genki Naruse
Takatomo Watanabe
Hiroyuki Okura
author_sort Genki Naruse
collection DOAJ
description Abstract Background Hereditary hemorrhagic telangiectasia, also known as Osler–Weber–Rendu disease, induces arteriovenous malformations in visceral organs. Arteriovenous malformations increase the risk of severe infections and are a common complication associated with hemorrhagic telangiectasia. However, cases of endocarditis associated with hemorrhagic telangiectasia are rarely reported. Although hemorrhagic telangiectasia causes erythematous macules on the extremities, these macules are usually painless. We encountered a rare case of infective endocarditis in a patient with Osler–Weber–Rendu disease. Case presentation A 52-year-old Japanese woman who was diagnosed with hemorrhagic telangiectasia 5 years prior presented to our hospital with fever and muscular pain. She had erythematous nodules and tenderness on the finger, heel, and toe, suggestive of Osler’s nodes. A physical examination revealed tachycardia with a 3/6 pansystolic murmur. A transesophageal echocardiogram showed vegetations along the atrial side of the mitral valve and mild mitral regurgitation because of prolapse of the anterior commissure. Methicillin-sensitive Staphylococcus aureus was identified in the blood cultures. Detection of distinctive skin lesions, so-called Osler’s nodes, was the symptomatic key to early diagnosis, and the patient was treated without surgery. She was discharged with negative blood cultures after a 6-week intravenous antibiotic administration. Conclusions Our report highlights the importance of considering the risk of extracerebral infections including endocarditis in hemorrhagic telangiectasia. This rare case effectively demonstrates the importance of proper diagnosis of skin lesions.
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spelling doaj.art-f25e4f7b8bd44c19b6efd980b4a298672022-12-22T00:35:13ZengBMCJournal of Medical Case Reports1752-19472022-05-011611410.1186/s13256-022-03427-2Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literatureGenki Naruse0Takatomo Watanabe1Hiroyuki Okura2Department of Cardiology, Gifu University Graduate School of MedicineDepartment of Cardiology, Gifu University Graduate School of MedicineDepartment of Cardiology, Gifu University Graduate School of MedicineAbstract Background Hereditary hemorrhagic telangiectasia, also known as Osler–Weber–Rendu disease, induces arteriovenous malformations in visceral organs. Arteriovenous malformations increase the risk of severe infections and are a common complication associated with hemorrhagic telangiectasia. However, cases of endocarditis associated with hemorrhagic telangiectasia are rarely reported. Although hemorrhagic telangiectasia causes erythematous macules on the extremities, these macules are usually painless. We encountered a rare case of infective endocarditis in a patient with Osler–Weber–Rendu disease. Case presentation A 52-year-old Japanese woman who was diagnosed with hemorrhagic telangiectasia 5 years prior presented to our hospital with fever and muscular pain. She had erythematous nodules and tenderness on the finger, heel, and toe, suggestive of Osler’s nodes. A physical examination revealed tachycardia with a 3/6 pansystolic murmur. A transesophageal echocardiogram showed vegetations along the atrial side of the mitral valve and mild mitral regurgitation because of prolapse of the anterior commissure. Methicillin-sensitive Staphylococcus aureus was identified in the blood cultures. Detection of distinctive skin lesions, so-called Osler’s nodes, was the symptomatic key to early diagnosis, and the patient was treated without surgery. She was discharged with negative blood cultures after a 6-week intravenous antibiotic administration. Conclusions Our report highlights the importance of considering the risk of extracerebral infections including endocarditis in hemorrhagic telangiectasia. This rare case effectively demonstrates the importance of proper diagnosis of skin lesions.https://doi.org/10.1186/s13256-022-03427-2Extracerebral infectionsHereditary hemorrhagic telangiectasiaInfective endocarditisOsler–Weber–Rendu diseaseSkin lesionsCase report
spellingShingle Genki Naruse
Takatomo Watanabe
Hiroyuki Okura
Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
Journal of Medical Case Reports
Extracerebral infections
Hereditary hemorrhagic telangiectasia
Infective endocarditis
Osler–Weber–Rendu disease
Skin lesions
Case report
title Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
title_full Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
title_fullStr Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
title_full_unstemmed Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
title_short Infective endocarditis with Osler’s nodule in a patient with Osler’s disease: a case report and review of the literature
title_sort infective endocarditis with osler s nodule in a patient with osler s disease a case report and review of the literature
topic Extracerebral infections
Hereditary hemorrhagic telangiectasia
Infective endocarditis
Osler–Weber–Rendu disease
Skin lesions
Case report
url https://doi.org/10.1186/s13256-022-03427-2
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