A 60-year-old woman was admitted through the outpatient
clinicwith a four-month history of weight loss, loss of appetite
and feverwith rigors and night sweats. She also complained of
increasedbreathlessness and tiny reddish lesions on the palms and
pulp ofthe fingers which were painful. She also had some
draggingsensation in the left hypochondrium. In the past, she was
operatedfor mitral valve stenosis by valvotomy. She was a
knownhypertensive and diabetic.
IMPORTANT CLUES ON CLINICAL EXAMINATION
On examination, she looked pale and had a temperature of
100F.She was clubbed and there were a few streaks in her nails.
Pulsewas 108 per minute regular, and all the pulses were palpable.
Heartsounds were normal, but there was a pan-systolic murmur at
mitralarea which radiated towards left axilla. Chest was clear
butabdominal examination revealed splenomegaly.
Neurologicalexamination was normal.
INVESTIGATIONS
Investigations included:
Hb: 8.4 g/dl Urine: traces of albumin(normocytic and a
fewnormochromic) RBCs per high
power field seen.WBC: 16.6 109/l Chest X-ray: mitralization of
the
P:71% L:21% left border of heartM:5% E:3% with prominent
Contd...
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8 Cardiology
Contd...
pulmonary bloodESR: 95 mm in 1st hour vessels.Sodium: 140
mmol/lPotassium: 4.3 mmol/lBicarbonate: 25 mmol/lChloride: 110
mmol/l
QUESTIONS
Q.1. What is the diagnosis?
Q.2. What further investigations would you ask for?Q.3. What
possible organisms are involved?
Q.4. What do you know in reference to Libman Sacks?
Q.5. What are the vasculitic lesions of this disorder?
