Endocarditis is a potentially life-threatening disease of the cardiac endothelium, most frequently involving the valves, caused by vegetations, infection, or both. Most cases of endocarditis are infectious, but it can also have noninfectious etiologies, such as in Libman-Sacks endocarditis, where vegetations form secondary to autoimmune disease. Additionally, endocarditis can present as either acute or subacute disease, and may be valvular or nonvalvular.

Nail and distal digit manifestations:

• The most common nail abnormalities seen in infective endocarditis are subungual splinter hemorrhages, which result from disruption of the fine capillaries along the subungual dermal ridges.
• Other cutaneous findings include petechiae, Osler nodes, and Janeway lesions.
• Finger clubbing may occur as a late sign.

Splinter hemorrhages seen together with tender nodules of the finger or toe pads or painless macules of the palms or soles suggest the diagnosis of subacute bacterial endocarditis.