History and physical examination: the cornerstones of the third millennium in medicine

Woman, 76aa, log on to first aid point of for fever, sore throat and polyarthralgia 2 weeks EO: right knee arthritis, palpable cervical-axil-lary lymphnodes, soft ankle edema,functional impairment with pain in shoulder blades, small flat scar interscapular hepatosplenomegaly con-firmed by US. Lab tests: marked phlogosis (VES: 57 mm/h; PCR: 35mg/dl) with rise ferritin and procalcitonin (0,89 pg/ml), anemia, neutrophilic leucocytosis (20000/ml), 3 out of 3 blood cultures pos for MSSA, pos RF, no consumption of complement, immune serology neg-ative CT chest-abdomen: structural upheaval right subscapularis mus-cle to cystic degeneration, with uptake of contrast medium (measures: 13 x 12 cm). Smaller similar injury to the left of the subscapularis (7x6 cm), with colliquativa of deltoid and infraspinatus TTE: thickened an-terior mitral cusp TEE: small non-mobile vegetations on mitral valve, in resolution.After review of anamnesis,previous month excision of small lipoma interscapular,without sequelae and surgical wound in order to follow-up. We therefore posed diagnosis of sepsis with infection of soft tissues of shoulder girdle, associated with bacterial endocarditis by MSSA. After 1 month of continuous IV infusion prolonged antibiotic therapy, patient’s overall conditions were satisfactory. Emblematic case of soft tissue infection secondary to the front door by contiguity