October 1983

Asymmetric Septal Hypertrophy in the Differential Diagnosis of Endocarditis

Arch Intern Med. 1983;143(10):2024-2025. doi:10.1001/archinte.1983.00350100208054

To the Editor.  —The sudden onset of a heart murmur in a patient with fever, bacteremia, and a central venous catheter should raise the possibility of infective endocarditis until proved otherwise. The following case report describes a patient with these clinical features who did not have endocarditis.

Report of a Case.  —A 61-year-old woman, previously in good health, had acute myelomonocytic leukemia. On Feb 8, 1982, a right subclavian intravenous (IV) line was inserted for the administration of chemotherapy. Five days later, fever and chills developed, together with pain at the catheter site. On physical examination, the patient's temperature was 38.7 °C, her BP was 160/90 mm Hg, and her pulse rate was 100 beats per minute. There was a purulent discharge at the catheter site with evidence of cellulitis around it. Results of the rest of the examination were unremarkable. Laboratory data showed a hemoglobin level of 9 g/dL,

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