Impact and Etiology of Periungual Toe Infections in Neutropenic Patients

Abstract

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is a genetic disorder of abnormal vasculature that leads to an increased risk of bleeding, with recurrent epistaxis being the most common presentation. To our knowledge, we report the first described case of Staphylococcus epidermidis mitral valve endocarditis in a man with recurrent epistaxis due to HHT. We presume that nasal carriage of S epidermidis was the source of infection. Because it is the most common organism isolated from contaminated blood cultures, the patient’s initial presentation of S epidermidis bacteremia was misdiagnosed as a skin contaminant because he had no clear source of infection (eg, central venous catheter) and he was largely asymptomatic. We present this case to highlight the importance of recognizing the risk of infection in patients with HHT with organisms associated with nasal carriage such as S epidermidis.