Petechial Hemorrhages on the Soft Palate in Other Infective Endocarditis Contexts

Abstract

The occurrence of red spots on the soft palate of a patient with infective endocarditis1Kano Y, Harada Y. Red spots on soft palate: an atypical peripheral sign of infective endocarditis. Am J Med. https://doi.org/10.1016/j.amjmed2022.12.021. Accessed January 14, 2023.Google Scholar has been reported in the past. Ramsey et al2Ramsey RG Gunnar RM Tobin JR Endocarditis in the drug addict.Am J Cardiol. 1970; 25: 608-618Abstract Full Text PDF PubMed Scopus (85) Google Scholar reported the case of a 42-year-old man with Streptococcus viridans endocarditis in whom petechial hemorrhages on the soft palate and buccal mucosa occurred in association with the presence of Roth spots in the retina. The same authors also reported the case of a 26-year-old woman with Staphylococcus aureus endocarditis who had petechial hemorrhages on the soft palate in association with a hemorrhage in the right conjunctival sac.2Ramsey RG Gunnar RM Tobin JR Endocarditis in the drug addict.Am J Cardiol. 1970; 25: 608-618Abstract Full Text PDF PubMed Scopus (85) Google Scholar Hart et al3Hart AP Silverthorne LN A case of acute bacterial endocarditis.Can Med Assoc J. 1929; 21: 305-307Google Scholar reported the case of a 13-year-old girl in whom the peripheral manifestations of infective endocarditis comprised petechial hemorrhages in the soft palate and buccal mucosa, cutaneous petechial hemorrhages, and Roth spots. Additionally, that patient had metastatic sepsis characterized by bacterial meningitis that was culture positive for Streptococcus viridans. The patient subsequently died. Autopsy disclosed the presence of vegetations on the mitral and tricuspid valves. Many petechial hemorrhages were documented in the pericardium, spleen, and kidneys. Although Servy et al4Servy A Valeyrie-Allanore L Alla F et al.Prognostic value of skin manifestations of infective endocarditis.JAMA Dermatol. 2014; 150: 494-500Crossref PubMed Scopus (52) Google Scholar declared “A dermatological physical examination is essential for the management of IE (infective endocarditis),” the evaluation of a patient with suspected infective endocarditis cannot be complete unless a search is also made for extracutaneous stigmata such as conjunctival hemorrhages, Roth spots, and, most importantly, petechial hemorrhages in the buccal mucosa, hard palate, and soft palate.2Ramsey RG Gunnar RM Tobin JR Endocarditis in the drug addict.Am J Cardiol. 1970; 25: 608-618Abstract Full Text PDF PubMed Scopus (85) Google Scholar Given the fact that, in addition to petechial hemorrhages on the soft palate, the patients reported by Ramsey et al2Ramsey RG Gunnar RM Tobin JR Endocarditis in the drug addict.Am J Cardiol. 1970; 25: 608-618Abstract Full Text PDF PubMed Scopus (85) Google Scholar and Hart et al3Hart AP Silverthorne LN A case of acute bacterial endocarditis.Can Med Assoc J. 1929; 21: 305-307Google Scholar also had Roth spots, it would be interesting to ascertain whether the patient reported by Kano et al1Kano Y, Harada Y. Red spots on soft palate: an atypical peripheral sign of infective endocarditis. Am J Med. https://doi.org/10.1016/j.amjmed2022.12.021. Accessed January 14, 2023.Google Scholar also had Roth spots as an additional peripheral sign of infective endocarditis.