Snapshot A 50-year-old man presents to the emergency room for a fever that has persisted for several days. He denies any history of intravenous drug use or any congenital heart disease. Physical exam reveals nailbed splinter hemorrhages, Osler nodes on his fingers, and Janeway lesions on his palms and soles. Heart auscultation reveals a new murmur. An echocardiogram shows vegetations on the mitral valve, and blood cultures that were drawn 12 hours apart were positive for Streptococcus bovis. Antibiotic therapy is started and he is scheduled for a colonoscopy. Introduction Clinical definition login to view 1 more bullet Epidemiology location login to view 3 more bullets risk factors login to view 5 more bullets Etiology Etiology login to view 26 more bullets Pathogenesis login to view 4 more bullets Presentation Symptoms login to view 6 more bullets Physical exam login to view 11 more bullets Imaging Echocardiography login to view 4 more bullets Evaluation Labs login to view 5 more bullets Making the diagnosis login to view 17 more bullets Duke Criteria Major Minor Positive blood cultures from 2 separate blood cultures drawn > 12 hours apart, or 3 out of 4 blood cultures that are positive, with first and last samples drawn 1 hour apart Abnormal echocardiogram with vegetation, abscess ,or partial dehiscence of prosthetic valve Fever Presence of risk factors, including intravenous drug use, structural heart disease, prosthetic heart valve, dental procedures, or history of endocarditis Vascular phenomena, including Janeway lesions, emboli, mycotic aneurysm, and conjunctival hemorrhage Immunologic phenomena, including glomerulonephritis, Osler nodes, and Roth spots Positive blood cultures not meeting major criterion Echocardiographic findings consistent with endocarditis but not meeting major criterion Differential Osteomyelitis login to view 2 more bullets Treatment Management approach login to view 2 more bullets Medical login to view 8 more bullets Operative login to view 6 more bullets Complications Cardiac complications login to view 3 more bullets Neurologic complications login to view 1 more bullet Prognosis often presents as fever of unknown origin endocarditis prophylaxis may be required before dental procedures