Cutaneous vasculitis in patients with infective endocarditis

Abstract

The aim of the work is to study the frequency and severity of cutaneous vasculitis (CV) in patients with infective endocarditis (IE), to analyze the relationship with damage to the heart valves, internal organs, and the outcome of the disease.

Materials and methods. Analysis of 359 patients with definite IE hospitalized from 2001 to 2019.

Results. CV syndrome of varying severity was detected in 69 patients, the frequency of CV in patients with IE was 19.2%. Skin rashes were noted in patients mainly in the form of symmetrically located petechial elements in the distal parts of the lower extremities (53 patients). In 15 cases, CV of a widespread nature was detected, and the primary skin elements were polymorphic. One patient was diagnosed with a bullous-necrotic form of CV. In the group of patients with IE and CV compared to patients with IE without skin symptoms, acute IE, intravenous drug use, coinfection with hepatitis C and B viruses, splenomegaly, kidney and eye damage, systemic embolism and neurological disorders were significantly more common (p<0.05). Patients with CV were distinguished by younger age, severity of anemia (decreased hemoglobin and red blood cell levels in 1 ml), daily proteinuria, increased serum transaminases, circulating immune complexes, erythrocyte sedimentation rate and C-reactive protein (p<0.05). No differences were found in the localization and number of affected heart valves, severity of heart failure, or rhythm disturbances in the study groups (p>0.05). 48 (69.5%) patients with IE and cutaneous vasculitis were discharged with significant improvement/stabilization of the condition of the underlying disease and a simultaneous decrease in skin manifestations, up to their complete disappearance against the background of antibacterial therapy. The risk of death is higher in the presence of cutaneous vasculitis (odds ratio – 2.32, 95% confidence interval: 1.27–4.3; p<0.05).

Conclusions. The presence of cutaneous vasculitis syndrome in patients with IE, especially at the onset of the disease, complicates timely diagnosis, can serve as a basis for differential diagnosis and should be taken into account when prescribing therapy and determining the tactics of managing patients with IE. With an established diagnosis of IE, skin symptoms often resolve against the background of standard antibiotic treatment.