Abstract: Infective endocarditis, characterized by microbial infection of the endothelial surface of the heart, can have numerous symptoms and signs. Typically they include fever, chills, a new or changing heart murmur, and bacteremia. Infective endocarditis can appear in an atypical manner and pose a diagnostic challenge. In such cases, initial signs and symptoms might be those from a complication. Purpura is a rare occurrence in the course of bacterial endocarditis but may be a prominent sign of this disease. This report concerns a patient with streptococcal infection of the mitral valve, who presented with such striking purpura that the possibility of a primary coagulation disorder was seriously considered before the diagnosis of bacterial endocarditis was established.