History and Examination

23 years young male patient, who is a known case of rheumatic heart disease with prosthetic AV valve, on chronic anticoagulation therapy,  came with history of fever on and off since  1 month.  Physical examination revealed hepatomegaly with approximately 16 cm splenomegaly with systolic murmur over mitral area. Splinter hemorrhages were seen over finger nails and no other stigmata of endocarditis were found. Other systems were unremarkable.  All vitals were stable.

So, provisional diagnosis of Infective Endocarditis was made and patient was started on iv antibiotics.

Dr Mohd Sajid Umar