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Prolonged fever and a murmur in a 35-year-old man
  1. Akihiro Tanaka,
  2. Masami Nishino,
  3. Yasuyuki Egami,
  4. Ryu Shutta,
  5. Jun Tanouchi
  1. Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
  1. Correspondence to Dr Masami Nishino, Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-city, Osaka 591-8025, Japan; mnishino{at}

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Clinical introduction

A 35-year-old man was referred to our hospital for dyspnoea and prolonged fever of unknown origin for a month. He had a high-pitched pan-systolic murmur at apex radiating to the clavicular area. His laboratory data showed elevated inflammatory indices (white-blood cells 14 800/μL and C-reactive protein 8.26 mg/dL). A chest radiograph revealed a moderate cardiomegaly (cardiothoracic ratio=0.60), and an ECG revealed atrial fibrillation. Transthoracic and transoesophageal echocardiography were performed (see figures 1 and 2, videos 1, 2 and …

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