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Reprint Address: Benjamin Grugan, MD, Office of Emergency Medicine, John H. Stroger Jr Hospital of Cook County, 1950 W Polk Street, 7th Floor, Chicago, IL 60612
Affiliations
Department of Emergency Medicine John H. Stroger Jr., Hospital of Cook County 1950 W Polk Street, 7th Floor, Chicago, IL 60612
A 56-year-old man with a history of bioprosthetic aortic valve replacement presented
to the emergency department from the cardiology clinic with concern for COVID-19.
He was febrile to 39.0°C but was otherwise asymptomatic. On physical examination,
he exhibited a loud systolic murmur with vertical, nonblanching, reddish-brown lines
underneath the nail plates to the left hand, consistent with splinter hemorrhages
(Figure 1). No other signs of septic emboli were identified on physical examination. During
his admission, blood cultures returned positive for haemophilus parainfluenzae and his clinical course was complicated by left occipital lobe infarction with consequent
visual loss to the left eye. A 6-week antimicrobial course was initiated for bacteremia
resolution and he was followed closely by cardiothoracic surgery for prosthetic valve
endocarditis.
Figure 1Vertical, nonblanching, reddish-brown lines underneath the nail plates to the left
hand consistent with splinter hemorrhages.
