Dear Aj DK:
Yes, there are 2 kinds of skin lesions!?! The first one ran on over this passing 1 year characterizing with non-scaly erythematous papules on the dorsum of hands, extensor surface of both arms and forearms. The second one developped during the hospitalization characterizing with painful hemorrhagic vesicles/blebs/nodules over palms and fingers. And the histopath demonstrated focal epidermal necrosis; dense dermal nodular infiltration of lymphocytes, histiocytes and neutrophils with neutrophilic abscesses; necrotic of sweat glands; in association with fibrin thrombi in blood vessels.
All these findings are the clues!!??!!
Even there is oscillating or pedunculated mass in the heart, it's still very difficult to distinguish between infectious process (IE), collagen vascular diseases (eg Libman–Sacks endocarditis in SLE), and malignancy (marantic endocarditis).
Chusana
