A Male with Chills and Arthralgias

A 53-year old man presented to the ED with complaintsof fevers and chills for 5 days. Two days prior, he startedhaving generalized arthralgias and a painfully numb leftindex finger. Similar symptoms had also begun on hisleft great toe (See Figures D and E, Color Plates page19). The patient denied recent trauma, although he wasunsure if he had sustained an insect bite on the dorsalaspect of his left hand 8 hours prior to the onset ofsymptoms. Three sets of blood cultures obtained priorto admission were positive for methacillin-sensitiveStaphylococcus aureus. The patient was treated withintravenous nafcillin and gentamicin. A transesophagealechocardiography was performed, which showed a friableand perforated left coronary cusp of the aortic valve,resulting in severe aortic insufficiency. The patient wasscheduled for emergent aortic valve replacement. It wassurmised that the initial site of infection was a badlyulcerated blister located on the patient’s right great toe