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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 …
Contributors All authors substantially contributed to the work and meet the authorship criteria as follows; conception and design, or analysis and interpretation of data: AT, YE, RS. Drafting the article or revising it critically for important intellectual content: MN. Final approval of the version to be published: MN, JT.
Competing interests None.
Patient consent Obtained.
Ethics approval The medical ethics committee at Osaka Rosai Hospital.
Provenance and peer review Not commissioned; internally peer reviewed.