Septic Embolus

Bacterial endocarditis can manifest itself in many different ways:  neurologic focal changes due to embolic strokes, evidence of acute heart failure (Jugular Venous Distention, dependent edema, etc.) and, of course, those signs that are near and dear to our hearts, the cutaneous and pericutaneous manifestations.  

Think of it this way:  The infected valve (usually the mitral) has vegetations which are peeled off from time to time by the turbulent flow across the valve, and the emboli float around until they ball-valve into a narrow vessel.  That's where we see them. So, you can have petechiae, such as the conjunctival petechia above, or it can play out as splinter hemorrhages in the nails (note: SBE is not the only way one can get splinter hemorrhages), Osler's nodes (tender digital nodules), Janeway Lesions (nontender palmoplantar nodules) and Roth Spots (retinal hemorrhages).  

The reason for this subtle example is because you, as incredibly astute diagnosticians, won't know it if you haven't seen it.  Remember: we, along with the ophthalmologists, are the detectives in medicine.  When everyone else fails, they come to us.