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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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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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