one and half yr old presented with fever for 10days and blackish discolouration of toes since 8days which is increasing. Liver just palpable and 1cm spleen. Pansystolic murmur on mitral area on auscultation. Discuss.



sub acute infective endocarditis,blood culture and echo at earliest,any history of congenital heart disease,immunosuppresion,use of steroids,dental caries, go with iv 3rd generation cephalosporin and iv amikacin and step up or step down based on culture reports and clinical improvement

Infective endocarditis....

CHD may lead to sepsis eg infective endocarditis or coagulopathy.. which may lead to thrombosis or emboli resulting in such picture....

Echocardiography to be done. .A case infective endocarditis. Embolism involving the terminal artery of great toe has resulted in evolving gangrene

i agree with Dr manish varma

apart from infective endocardits.......a d/d of connective tissue disorder. Let us know the outcome n final dx

I agree with Dr.Manish verma

Infective endocarditis leading to embolic phenomenon

CHD with infective endocarditis with embolism


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