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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}orh.go.jp

https://doi.org/10.1136/heartjnl-2014-305519

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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, …

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    Footnotes

    • 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.

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