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....

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

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

Echocardiography to be done. .A case infective endocarditis. Embolism involving the terminal artery of great toe has resulted in evolving gangrene

It is not kawasaki disease, in which there is peeling of skin not blackning. It is gangrenous lesion secondary due to emboli. do ECHO and doppler

1) infective endocarditis 2) sepsis causing gangrene/ consumptive coagulopathy with functionak murmur 3) Kawasaki disease

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

Septic embolisation from underlying infective endocarditis.

Features suggestive of infective endocarditis

should consider Rickettsial disease

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