{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T08:08:06Z","timestamp":1753862886213,"version":"3.41.2"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Infective endocarditis (IE) rarely presents with cutaneous manifestations due to earlier diagnosis and treatment. We present a case of middle\u2010aged male patient presenting with an erythematous papular rash in the upper extremities and left knee, further progressing into painful ulcers with crusted and necrotic center in the arms and fingers. These cutaneous lesions were further followed by shaking chills and fever, which brought the patient to our hospital. Laboratory evaluation revealed elevated ESR (erythrocyte sedimentation rate) and C\u2010reactive protein. Blood cultures taken were negative. Biopsy of the skin lesions were consistent with cutaneous leukocytoclastic vasculitis, and the gram smear revealed gram\u2010positive cocci. The patient developed dyspnea and chest pain, which raised suspicion for IE. TEE (transesophageal echocardiography) demonstrated mild LV diastolic dysfunction, 1+ tricuspid valve regurgitation, mild mitral regurgitation, and vegetation\u2010like lesions on the surface of mitral valve leaflets, consequently IE was confirmed. In conclusion, clinicians must look carefully for skin manifestations in cases with high likelihood of IE, even when other typical symptoms are absent.<\/jats:p>","DOI":"10.1002\/ccr3.7027","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T05:05:27Z","timestamp":1685509527000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Blood culture\u2010negative infective endocarditis presenting with atypical dermatologic manifestation: A rare case report and review of the literature"],"prefix":"10.1002","volume":"11","author":[{"given":"Maedeh","family":"Najafizadeh","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Assistant Professor of Infectious Diseases, Kashan School of Medicine Kashan University of Medical Sciences  Kashan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1256-675X","authenticated-orcid":false,"given":"Fatemeh","family":"Dashti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kashan School of Medicine Kashan university of medical sciences  Kashan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamed","family":"Pahlevani","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kashan School of Medicine Kashan University of Medical Sciences  Kashan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farzad","family":"Kamalizad","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kashan School of Medicine Kashan university of medical sciences  Kashan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-1365","authenticated-orcid":false,"given":"Seyed Mohammad 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