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Harada H, Nakamura K, Koyama Y, Kikuchi K, Iwano H, Nabuchi-Kawasaki M, Kubono Y, Sano M, Serizawa Y, Tetsuya H. Mural infective endocarditis with a mass on the fossa ovalis in the right atrium. J Infect Chemother 2024:S1341-321X(24)00106-5. [PMID: 38570138 DOI: 10.1016/j.jiac.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Infective endocarditis (IE) is a life-threatening disease that affects the endocardial surface of the heart. Although heart valves are commonly involved in IE, in rare cases, vegetation is attached to the cardiac walls without valvular endocardial involvement, which is referred to as mural IE. In this case, a 60-year-old female presented with a seven-day history of fever associated with worsening pain in the right shoulder and left hip. Streptococcus dysgalactiae subsp. Equisimilis was detected in both blood and joint fluid cultures. Although transthoracic echocardiography revealed no mass, transesophageal echocardiography revealed a mobile mass in the fossa ovalis of the right atrium. She was subsequently diagnosed with mural IE and successfully treated with antibiotics without cardiac surgery. To our knowledge, only a few reports have described mural IE with vegetation in or around the fossa ovalis of the right atrium. This case highlights the importance of transesophageal echocardiography in diagnosing mural IE. The treatment strategy for mural IE should be discussed individually and in a multidisciplinary manner because current IE guidelines may not be applicable to mural IE cases due to differences in disease characteristics and clinical course between mural and valvular IE.
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Affiliation(s)
- Hiroki Harada
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
| | - Kaito Nakamura
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yuki Koyama
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Koki Kikuchi
- Department of Infectious Diseases, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyuki Iwano
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | | | - Yuta Kubono
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Megumi Sano
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yoshimoto Serizawa
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hoshi Tetsuya
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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