<s>[INST] context: Janeway lesion are nontender, macular and erythematous lesions on palms and soles of patient with acute infective endocarditis. Osler nodes are tender, violaceous nodules typically located in pulp of fingers and toes seen in patient with infective endocarditis. Libman Sack endocarditis occurs in up to 25% of patient with SLE. This condition can cause small cardiac valvular vegetations on wither side of a valve, resulting in fibrotic valve thickening in fibrotic valve thickening anf deformity. SLE may cause an acute coronary syndrome at young age even with angiographically normal coronary aeries. Rheumatic fever can lead to mitral stenosis, which is characterize by a late, rumbling, diastolic murmur at cardiac apex. Numerous symptoms are associated with acute rheumatic fever, these can be: fever, erythema marginatum, valvular damage, increase ESR, joint pain, Subcutaneous nodule and Sydenham chorea. Erythema marginatum is a nonpruritic, circular, pink eruption on the trunk that is present in few cases of acute rheumatic fever. Kaposi sarcoma: a vascular tumor that is the most common neoplasm in patients with AIDS.The lesions of KS are characterized by the proliferation of spindle-shaped cells that express markers of both endothelial cells (vascular or lymphatic) and smooth muscle cells. [/INST] question: A 32 yr old man present to ER with history of high-grade fever, dyspnea and fatigue. On physical examination reveals a new holosystolic murmur that is best heard over cardiac apex. Skin examination shows following skin lesion. What is most likely diagnosis? | options: A: Rheumatic hea disease B: Infective endocarditis C: Libman sack endocarditis D: Kaposi sarcoma | answer: B </s>