Nódulos de Osler e Lesões de Janeway: Da Clínica ao Diagnóstico

A 58-year-old man, with medical background of mitral valve prolapse and dental caries presented with a 12-day evolution of fever, malaise, low back pain and decreased visual acuity. Physical examination revealed small tender purplish nodules on palms of both hands (Fig. 1) and macular hemorrhagic lesions on the right foot (Fig. 2). No recent dental treatments were reported. Complementary study showed mitral valve endocarditis, lumbar spondylodiscitis and retinitis. A methicillin-resistant Staphylococcus aureus was isolated from blood cultures. The patient developed mitral regurgitation due to tendinous cord’s rupture, requiring urgent valve replacement. Valvular vegetations revealed the same agent. Antibiotic treatment with vancomycin, and posteriorly linezolid, led to resolution of the lesions and clinical improvement.