Recurrent ischemic stroke and palmoplantar pustulosis caused by occult postoperative infective endocarditis

Abstract

Stroke is occasionally the first manifestation of occult infective endocarditids. Although infective endocarditids commonly presents acutely, infective endocarditids remains a diagnostic challenge in a patient with few symptoms or culture-negative endocarditis. Here, we present a 74-year-old Japanese woman with recurrent ischemic stroke and palmoplantar pustulosis caused by occult postoperative infective endocarditids. She had undergone an operation for mitral regurgitation, mitral annuloplasty, 4 years before admission. Intriguingly, our patient suffered from intractable palmoplantar pustulosis after cardiac surgery, but the patient's cutaneous manifestations completely resolved after treatment of occult postoperative infective endocarditids. In patients with unexplained intermittent fever and palmoplantar pustulosis after cardiac surgery, clinicians need to consider the possibility of occult postoperative infective endocarditids.