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Article
March 1988

Bacterial Endocarditis Following Nail Trauma

Arch Intern Med. 1988;148(3):752-754. doi:10.1001/archinte.1988.00380030258046

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Abstract

To the Editor.  —I became aware of subungual hematoma in patients suspected of bacterial endocarditis (BE) after one of our patients with definite (histologically proved) BE caused by Staphylococcus aureus reported a nail trauma with the appearance of a subungual hematoma, just two days before the start of the clinical signs of his disease.Since then, three of eight consecutive patients with BE were found to have a subungual hematoma and all gave a history of nail trauma preceding their clinical disease (Figure). In one of these patients, the etiologic agent was Staphylococcus epidermidis, while the other two had culture-negative BE, related probably to antibiotic treatment initiated at home before a blood culture could be obtained.One of these two patients had a definite vegetation on the tricuspid valve detected by echocardiography; while the second one was detected after mitral and aortic valve replacement, and he sustained a small brain

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