Back issues No.2 - 2004 / Resident Forum  

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A Patient of Esophageal Carcinoma Presenting with Fever and Multiple Nodules on Fingers
Yen-Chi Chou , Jing-Yi Lin , Hua-Hsin Chen , Hsin-Chun Ho
Dermatol Sinica 22 : 199-200, 2004

Case report
A 63-year-old man experienced progressive dyspnea of 1-week duration in August 2002. Esophageal squamous cell carcinoma with periesophageal soft tissue invasion had been diagnosed 1 year previously. He had been treated with tumor resection and 3 courses of chemotherapy. Two-dimensional cardiac echography showed large amount of pericardial effusion and a vegetation in the left atrium (Fig.1). After performing pericardiocentesis and sclerosing therapy with mitomycin, his symptoms improved. However, fever and chillness were noted in the following month. Physical examination revealed several 0.5- to 1-cm indurated tender nodules on right thumb and both fourth fingertips (Fig.2). These lesions appeared 1 week before the onset of fever and resembled septic emboli with peripheral erythema. Blood culture showed coagulase-negative staphylococcus and Streptococcus pneumoniae. Endocarditis with septic emboli was diagnosed and the patient was treated with antibiotics. Although his fever subsided, the skin lesions on both hands persisted.

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