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.

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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

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. typical lesions can be observed on fingers and toes and on nail beds

INFECTIVE ENDOCARDITIS WITH PERIPHRAL EMBOLISM & GANGRENE BLOOD CULTURE ECHOCARDIUM FOR VEGETATION OF INFECTIVE ENDOCARDITIS

Subacute bacterial endocarditis with emboli in toes causing infarction and necrosis Sent blood for culture and sensitivity and give IV antibiotic ceftriaxime till then Crocin syrup for febrile episodes

1. VSD with Infective Endocarditis. 2. ACHD (VSD) with Sepsis DOC 3. VSD with meninigococal septicaemia

Connective tissue disorder unlikely as age is not suggestive.
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Features suggestive of infective endocarditis

apart from infective endocarditis kawasaki disease and inflammatiry diseases of small vessels should be ruled out.echo to see the coronary vessels with doppler and blood investigion for inflammatory and infective markers to be done

Infective endocarditis leading to embolic phenomenon

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