24th May 2025

A 74-year-old male with a history of mitral stenosis secondary to rheumatic heart disease presents with lethargy, weight loss and feeling generally unwell for the last two weeks.

A 74-year-old male with a history of mitral stenosis secondary to rheumatic heart disease presents with lethargy, weight loss and feeling generally unwell for the last two weeks. His observations on triage show: BP 137/84mmHg, HR 98 bpm, SO2 98% on room air, RR18 and temperature of 38.3 °C. Your examination reveals the presence of several small, non-tender haemorrhagic macules over the patient’s palms. You suspect IE, and he is admitted for further investigations, including blood cultures. A TTE is performed and reveals the presence of partially calcified vegetations attached to the mitral valve. Two sets of blood cultures return positive for Streptococcus viridans. Appropriate antibiotics have been initiated after the blood cultures were taken. How many of the modified Duke’s criteria for infective endocarditis has this patient met?

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