PMC8238594_01
(a) Transthoracic echocardiogram showing multiple oscillating masses (yellow arrows) at anterior mitral valve leaflet with severe rheumatic mitral stenosis. (b) Gross findings of the resected mitral valve showing three large vegetations at anterior mitral valve leaflet. LV, left ventricle; LA, left atrium; RV, right ventricle.
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fig1
Transthoracic echocardiography indicated a left ventricular ejection fraction of 54%, moderate aortic regurgitation, severe rheumatic mitral stenosis, and multiple oscillating masses on the anterior mitral valve leaflet ranging from 1.5 cm to 2.4 cm in diameter (Figure 1(a), yellow arrows). Three large vegetations on the anterior mitral valve leaflet were identified during emergency open-heart surgery (Figure 1(b)), and a mechanical prosthetic mitral valve was placed.
(a) The colonies of mold form. (b) Lactophenol cotton blue stain showing hyphae with numerous tuberculate macroconidia.
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fig2
The sputum and vegetation cultures grew H. capsulatum (Figures 2(a) and 2(b)) after 1 week of incubation.