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The case reported by Drs Klotstein and Shilo is very interesting indeed. I believe it is somewhat different from the cases we reported in that any obvious local thigh lesions were not noted in any of our cases. None of our patients appeared to have suffered from endocarditis, but I have seen cases of relapsing endocarditis in which the major clinical manifestation was bilateral anterior thigh pain; no focal thigh lesions developed in these patients and the pain and tenderness disappeared on reinstitution of therapy.
As more data accumulate, it will be interesting to see what proportion of those patients with endocarditis in whom thigh pain and/or tenderness develop will manifest the syndrome we described, and what percentage will show the intriguing focal lesions described by Drs Klotstein and Shilo.
Louria DB. Anterior Thigh Pain or Tenderness-Reply. Arch Intern Med. 1986;146(6):1226. doi:10.1001/archinte.1986.00360180246043