SHM Converge Scientific Abstract ePoster Gallery-The "Other Sti" Sexually Transmitted Ischemia

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This case describes a 52-year-old man with a history of IV drug use who presented with sudden right leg numbness, weakness, severe thigh pain, and a cold, pulseless lower extremity. He also had prodromal fevers, sweats, arthralgias, leukocytosis, and a loud systolic murmur. CTA showed occlusion of the right common femoral and distal superficial femoral arteries, and TTE revealed a 1.6 cm mitral valve vegetation.<br /><br />He was diagnosed with acute limb ischemia caused by septic embolization from infective endocarditis. Although initial blood cultures were negative, thromboembolectomy with embolus tissue culture grew Neisseria gonorrhoeae, establishing the diagnosis of gonococcal endocarditis. He was treated with heparin, ceftriaxone, and azithromycin, and mitral valve repair was planned, but he left before surgery.<br /><br />The presentation highlights two teaching points:<br />1. Limb ischemia should be categorized by etiology and time course:<br />   - Acute: symptoms present less than 14 days<br />   - Acute on chronic: worsening over 14 days<br />   - Chronic: stable ischemic symptoms over 14 days<br />   - Major causes include thrombosis, embolus, and other less common etiologies<br />2. In culture-negative infective endocarditis, embolic tissue culture can be a valuable diagnostic tool and should be specifically requested.<br /><br />Overall, the case emphasizes that gonococcal endocarditis is rare but potentially life-threatening, and embolic events may be the first clue to the diagnosis.

Asset Subtitle

Caleb W. Phillips

Meta Tag

Author List Caleb W. Phillips, Kristen E. Fletcher, Madison C. Dressler, Travis Combs

Category Clinical Vignettes

Concept Limb Ischemia

Concept Acute Limb Ischemia

Concept Thrombosis

Concept Embolism

Concept Infective Endocarditis

Distinguished Non-Finalist

Presenter Organization University of Kentucky - Internal Medicine

Presenting Author Caleb W. Phillips

Track Adult

Keywords

acute limb ischemia

septic embolization

infective endocarditis

gonococcal endocarditis

Neisseria gonorrhoeae

mitral valve vegetation

culture-negative endocarditis

thromboembolectomy

common femoral artery occlusion

IV drug use

Limb Ischemia

Acute Limb Ischemia

Thrombosis

Embolism

Infective Endocarditis