PMC9425258_01
Infective endocarditis complicating systemic embolism (the arrows indicate areas of interest) and detection of key genes. (A) Color Doppler echocardiography showing the vegetation attached to the anterior mitral valve leaflet. (B) Spiral computed tomography showing renal infarction. (C) Echocardiographic examination showing embolization of the right common iliac artery and right internal and external iliac arteries. (D) Computed tomography of the brain showing multiple low-density lesions. (E). Detection of antimicrobial genes, virulence-related genes and adhesion genes by PCR amplification. Lane 1, molecular weight marker; lane 2, mecA; lane 3, ermC; lane 4, blaZ; lane 5, clfA; lane 6, clfB; lane 7, icaA; lane 8, efb; lane 9, fnbA; lane 10, hlb; lane 11, hld; lane 12, hlg2.
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During the next two days, echocardiography revealed large vegetation on the anterior mitral valve leaflet (3 cm x 3 cm) with moderate mitral valve regurgitation (Fig. 1A) Spiral computed tomography (CT) showed renal and splenic infarction (Fig. 1B). Embolization of the right common iliac artery and right internal and external iliac arteries was seen on echocardiography (Fig. 1C). Carbomedics mechanical valve. Considering the presence of coma and fever (39.8  C) postoperatively, brain CT was obtained and showed multiple low-density lesions in temporal lobes, right parietal lobe, and occipital lobe, suggestive of cerebral embolism (Fig. 1D). The genome of the MRSA isolate encoded three hemolysin genes (hlb, hld and hlg2) and five adhesion genes (clfA, clfB, fnbA, efb and icaA) (Fig. 1E).