Professorial Unit in Medicine, National Hospital of Sri Lanka, Colombo, 01000, Sri Lanka.
Department of Clinical Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
BMC Infect Dis. 2023 Jul 6;23(1):451. doi: 10.1186/s12879-023-08439-x.
Osler's nodes, Janeway lesions and splinter haemorrhages are cutaneous manifestations of infective endocarditis. They occur due to vascular occlusion by septic emboli and a resulting localized vasculitis. They are usually bilateral. We report a case of unilateral Osler's nodes, Janeway lesions and splinter haemorrhages due to an ipsilateral surgical arterio-venous fistula infection.
A fifty-two-year-old Sri Lankan female with end stage kidney disease presented with fever for five days with blurred vision, pain and redness of the right eye. She had a left brachio-cephalic arterio-venous fistula (AVF) created one month back. She complained of a foul-smelling discharge from the surgical site for past three days. Redness of the right eye with a hypopyon was noted. AVF site over the left cubital fossa was infected with a purulent discharge. Osler's nodes, Janeway lesions and splinter haemorrhages were noted in the distal fingers, thenar and hypothenar eminences of the left hand. Right hand and both feet were normal. No cardiac murmurs were heard. Blood cultures, vitreous sample cultures and pus cultures from the fistula site were all positive for methicillin sensitive Staphylococcus aureus. Infective endocarditis was excluded by a trans-oesophageal echocardiogram. She was treated with IV flucloxacillin and surgical excision of the AVF.
Infections of AVF can result in septic emboli formation which can have both anterograde arterial embolization and retrograde venous embolization. Arterial embolization can result in unilateral Osler's nodes, Janeway lesions and splinter haemorrhages. Venous embolization can cause metastatic infections in the systemic and pulmonary circulations.
奥尔斯勒结节、杰纳eway 损害和裂片状出血是感染性心内膜炎的皮肤表现。它们是由于感染性栓子引起的血管阻塞和随之发生的局部血管炎所致。它们通常是双侧的。我们报告一例由于同侧手术动静脉瘘感染导致单侧奥尔斯勒结节、杰纳eway 损害和裂片状出血。
一名 52 岁的斯里兰卡女性，患有终末期肾病，出现发热 5 天伴视力模糊、右眼疼痛和发红。她在一个月前建立了左侧肱动脉-头静脉动静脉瘘（AVF）。她诉述过去 3 天手术部位有恶臭分泌物排出。发现右眼发红，伴有前房积脓。左侧肘窝处 AVF 部位感染，有脓性分泌物排出。左手远节指骨、大鱼际和小鱼际出现奥尔斯勒结节、杰纳eway 损害和裂片状出血。右手和双脚正常。未闻及心脏杂音。血培养、玻璃体样本培养和瘘管部位脓液培养均为甲氧西林敏感金黄色葡萄球菌阳性。经经食管超声心动图排除感染性心内膜炎。给予 IV 氟氯西林和手术切除 AVF 治疗。
AVF 感染可导致感染性栓子形成，可引起顺行性动脉栓塞和逆行性静脉栓塞。动脉栓塞可导致单侧奥尔斯勒结节、杰纳eway 损害和裂片状出血。静脉栓塞可导致全身和肺循环的转移性感染。
