If not Endocarditis, then what?
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An_247992 posted:
I have cardiomyopathy from pregnancy (dx 12 yrs ago) EF of 50%.

On June 12th I had bony oral surgery without antibiotic cover on infected tissue.
On June 18th I was running fever and experiencing night sweats
On June 22nd I started getting nail hemmorhages but the fever disappeared.
On June 25th (8 days post symptoms, 13 days post surgery) I had a regular echo, TEE and blood cultures. All negative.
On August 5th I had more Blood cultures and another regular echo (not TEE) - negative.
Everything negative, normal WBC, etc. I have also had fungal and Qfever cultures - negative.

Exhausted, still getting multiple splinter hemmorhages but no fever and rarely a night sweat.

Do you believe we have successfully ruled out Endocarditis? Where should I turn next?
Thanks!
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cardiostarusa1 responded:
Hi:

As reported, splinter hemorrhages (fingernail splinters) has various causes, including, swelling of the blood vessels causing vessel damage (vasculitis) or minute clots (thrombus) that damage the small capillaries (mico emboli).

"Do you believe we have successfully ruled out endocarditis?"
General info

Diagnostic Criteria

The diagnosis of endocarditis is usually based upon a combination of factors, including a careful history and physical examination, blood cultures and other selected lab test results, a resting electrocardiogram (ECG), a chest X-ray (CXR), and an echocardiogram (cardiac ultrasound).

Additionally

The diagnosis of endocarditis is usually based upon a constellation of clinical findings rather than a single definitive test result. The diagnosis is usually obvious if/when a patient has the characteristic findings:

Several positive blood cultures in the presence of a well recognized predisposing cardiac lesion.

Evidence of endocardial involvement


However, some patients with endocarditis do not have positive blood cultures (culture-negative endocarditis), and approximately one-third to one-fourth of patients have no identifiable predisposing cardiac lesion at disease onset. The presence of atypical features may result in misdiagnosis or a correct diagnosis that is delayed.

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Best of luck down the road of life.

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