PDF(Pubmed)
Abstract：
Infective endocarditis (IE) can present with a variety of signs and symptoms, including skin lesions. The few papers describing a relationship between IE and vasculitis are split between IE being able to mimic vasculitis and between IE indeed being associated with a vasculitis involving the skin, kidney, gastrointestinal tract, or peripheral nerves. It is important for clinicians to distinguish between an isolated vasculitis, infective endocarditis, and IE-associated vasculitis because the treatments and outcomes are different. We report a case of a patient with a history of intravenous (IV) drug use who initially presented with chest pain, was started on vancomycin following diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) IE, left against medical advice (AMA), and then returned to the hospital due to development of a purpuric rash. We contend that while he did not have a skin biopsy due to time delay, his symmetrically distributed purpura was consistent with cutaneous vasculitis. His symptoms, including his rash and an acute kidney injury (AKI), improved with antibiotics to treat the endocarditis.
摘要：
感染性心内膜炎（IE）可表现为多种体征和症状，包括皮肤损伤。描述IE和血管炎之间关系的几篇论文分为IE能够模仿血管炎和IE确实与涉及皮肤的血管炎有关，肾,胃肠道,或周围神经。对于临床医生来说，区分孤立性血管炎是很重要的，感染性心内膜炎,和IE相关血管炎，因为治疗和结果不同。我们报告了一例有静脉（IV）药物使用史的患者，最初表现为胸痛，在诊断耐甲氧西林金黄色葡萄球菌（MRSA）IE后开始使用万古霉素，离开医疗建议(AMA)，然后因出现紫癜性皮疹而返回医院。我们认为，尽管由于时间延迟他没有进行皮肤活检，他的对称分布紫癜与皮肤血管炎一致。他的症状,包括皮疹和急性肾损伤(AKI),用抗生素治疗心内膜炎。
