Infective endocarditis: Revisiting classical signs of enduring relevance

A 17-year-old previously healthy girl presented with 7 days of fever and classical peripheral findings including Osler's nodes, Janeway lesions, splinter hemorrhages, and Roth's spots. Echocardiography revealed a large vegetation attached to the posterior mitral leaflet. Blood culture later grew methicillin-sensitive Staphylococcus aureus. Despite antibiotic therapy, the vegetation increased in size with splenic embolization, requiring urgent mitral valve replacement. This case highlights the enduring diagnostic value of classical clinical signs, now rarely seen in high-income settings but still encountered in resource-limited regions, and emphasizes the importance of early echocardiographic evaluation in such presentations.