**8.5. Septic emboli to extremities**

Distal septic emboli are well described in the setting of IE [30, 129]. A nontrivial proportion of SE associated with IE requiring valvular replacement affects the extremities, with some patients experiencing multiple embolic events [30, 129]. Clinical manifestations can vary from extremity pain to limb-threatening ischemia [30]. In less severe cases, ischemic symptoms may resolve with anticoagulation and antimicrobial therapy, while in more acute presentations surgical embolectomy or even amputation may be required [30].

#### **8.6. Arterial lesions associated with septic embolism**

Secondary arterial changes and associated lesions have been reported in the setting of infectious embolization [75, 130]. Inflammatory changes were noted in the walls of arteries adjacent to an intracranial hematoma following septic embolization [75]. In one instance, brachial artery pseudoaneurysm (**Figure 8**) has been described in the setting of severe prosthetic aortic valve endocarditis [2]. In another case, a ruptured mycotic aortic abdominal aneurysm occurred in a child with SE following the resection of an infected cardiac myxoma [131]. Due to rarity of such arterial lesions and the associated nonspecific clinical presentation(s), it is extremely important to maintain a high index of suspicion when potential infections of arterial structures are identified.

**Figure 8.** Large (2.5 cm) brachial artery pseudoaneurysm secondary to septic embolization from prosthetic aortic valve endocarditis. Source: Stawicki et al. [2]. Used under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

#### **8.7. Uncommon presentations involving the central nervous system**

Exceedingly rare, septic embolism may involve the spinal cord and lead to associated spinal cord infarction [132, 133]. In such cases, other organs are likely to become involved as well, including the kidneys and pulmonary circulation [132]. Finally, septic embolism to the retina has been reported in the setting of staphylococcal tricuspid endocarditis in intravenous drug abusers [119].
