Case report: livedo reticularis in endocarditis.

The peripheral manifestations of bacterial endocarditis are manifold and provide diagnostic clues as to the onset, etiology and potential complications of the disease. Petechiae, splinter hemorrhages, and Osler's nodes are among the more common cutaneous signs of endocarditis thought to be secondary to an allergic vasculitis or, as in the case of Osler's nodes, peripheral emboli. An asymmetric livedo reticularis rash was the initial presentation in a patient we recently treated with peptostreptococcus intermedius endocarditis, a heretofore undescribed dermal sign of endocarditis. Immunofluorescence studies of skin biopsies suggest that a livedo reticular rash may be one of the immune complex vasculitic syndromes associated with endocarditis.