Advertisement

Red spots on soft palate: an atypical peripheral sign of infective endocarditis

  • Yasuhiro Kano
    Correspondence
    Corresponding author: Yasuhiro Kano, Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan, TEL: (+81) 42-323-5111, FAX: (+81) 42-323-9209
    Affiliations
    Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan
    Search for articles by this author
  • Yukinori Harada
    Affiliations
    Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
    Search for articles by this author
Published:January 13, 2023DOI:https://doi.org/10.1016/j.amjmed.2022.12.021
      A 35-year-old man presented with a five-day history of fever with chills, night sweat, and fatigue. He had a history of congenital ventricular septal defect, which was observed without treatment. He was receiving no medication at the time and had no allergic episode. He was a current smoker had smoked 1-packs-per-day of cigarettes and drank 2 liters of beers each day for 15 years but quit both five days before the presentation. A physical examination revealed multiple dental caries. A cardiovascular examination revealed a harsh, holosystolic murmur which was loudest (intensity grade of 3/6) at the left middle to lower sternum. The rest of the physical examination was unremarkable, and there were no peripheral signs of infective endocarditis, such as Osler's nodes, Janeway's lesions, splinter hemorrhage or petechiae on the mucosal lesions. Laboratory tests revealed elevated C-reactive protein at 11.2 mg/dL (reference range <0.30 mg/dL), an elevated erythrocyte sedimentation rate at 83 mm/hr (reference range <10 mm/hr), and positivity for rheumatoid factor (29 IU/mL; reference range <15 IU/mL). Two sets of blood culture were obtained, and follow-up was scheduled for three days later. Three days after the first visit, the blood cultures grew Aggregatibacter aphrophilus on chocolate agar. A definitive diagnosis of infective endocarditis was made based on the modified Duke criteria. The patient was admitted immediately for treatment. On admission, repeated physical examinations found three, reddish, painless patches on the soft palate (Figure 1, arrows) which were not present at his first visit. No other changes were observed. Treatment with intravenous ceftriaxone was begun, and the palatal spots resolved by the next day. Subsequent transthoracic and transesophageal echocardiography denied vegetation. The red spots never recurred.
      Figure 1:
      Figure 1(A) Three reddish spots with indistinct margins on the soft palate (arrows) and multiple caries.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Servy A
        • Valeyrie-Allanore L
        • Alla F
        • et al.
        Prognostic value of skin manifestations of infective endocarditis.
        JAMA Dermatol. 2014; 150: 494-500
        • Fukuda M
        • Harada T
        • Shimizu T
        • Hiroshige J.
        Forchheimer Spots in Rubella.
        Intern Med. 2020; 59: 1673
        • Koplik H.
        The diagnosis of the invasion of measles from a study of the exanthema as it appears on the buccal mucous membrane.
        Arch Pediatr. 1896; 13: 918-922
        • SHIVER Jr, CB
        • BERG P
        • FRENKEL EP
        Palatine petechiae, an early sign in infectious mononucleosis.
        J Am Med Assoc. 1956; 161: 592-594
        • Yamamoto K.
        Oral Manifestation Like Forchheimer Spots of Dengue Fever.
        Am J Trop Med Hyg. 2019; 101: 729
        • Chambers ST
        • Murdoch D
        • Morris A
        • et al.
        HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.
        PLoS One. 2013; 8: e63181