An adult patient presents with fever and a new regurgitation murmur. Blood cultures reveal the presence of Streptococcus viridans, and an echocardiogram shows vegetations on the mitral valve. On examination, nontender, erythematous macules are present on her palms. What is the cause of this physical examination finding?
1) Septic emboli
2) Reaction to circulating bacterial endotoxins in the skin
3) Deposition of immune complexes in the small blood vessels
4) Hypersensitivity reaction to the bacteria in the skin
