PMC6111064_01
Chest and abdominal computed tomogram. Left (axial view): arrow shows a mass-forming lytic lesion at the left anterior sixth rib and more prominent bilateral pleural effusion at the right side. Right (sagittal view and bone window): image shows multiple lytic lesions in the spine.
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Chest and abdominal computed tomography scanning revealed a mass-forming lytic lesion at the left anterior sixth rib, multiple lymphadenopathy (0.8-3.4 cm in size) at the right supraclavicular, bilateral internal iliac, para-aortic, precaval, and retrocaval areas, and multiple lytic lesions over the whole spinal and pelvic areas (Fig. 1).
Transesophageal echocardiogram showing a vegetation at the aortic valve leaflet (0.9 x 0.5 cm in size).
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Transesophageal echocardiograms exhibited a vegetation at the aortic valve leaflet (0.9 x 0.5 c in size) (Fig. 2).
PCR amplification of pap31 gene. Lane M: 100 bp DNA ladder markers; Lane 1: DNA isolated from patient's blood sample; Lane 2: positive control bacterial DNA (B. henselae); Lane 3: negative control bacterial DNA (S. pneumoniae).
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DNA polymerase (Promega, WI, USA) and the specific primers PAP31F and PAP31R. The corresponding PCR product amplified from DNA obtained from another patient with proven B. henselae infective endocarditis was used as a positive control and a non-Bartonella bacterium (Streptococcus pneumoniae) was used as negative control. Direct DNA sequencing of the PCR product showed 99% homology with the B. henselae pap31 gene (Fig. 3); however, serological testing for Bartonella spp. was not performed.