PMC8550988_01
Transthoracic echocardiography in (a) parasternal long-axis view and (b) apical four-chamber view demonstrated severe mitral regurgitation (MR) with large oscillating mass at PML (white arrow).
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The echocardiography evaluation revealed mitral regurgitation (MR) with ruptured chordae tendineae, perforated leaflet, and multiple vegetation attached to both leaflets (Fig. 1).
The vertebrae magnetic resonance imaging. The coronal view with (a) T1 weighted (b) T2 post-contrast showed mild scoliosis with multiple small abscesses indicates spondylodiscitis L2-3, L5-S1 (white arrow) caused spinal canal compression at the level of L2-3. The axial view at the level of L2-3 with (c) T1 weighted (d) T2 post-contrast and at the level L5-S1 with (e) T1 weighted (f) T2 post-contrast also showed abscess (white arrow).
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Magnetic resonance imaging (MRI) for the spine revealed multiple small abscesses at L2-3, L5-S1 (Fig. 2).
The tissue pathology results of (a and b) the lumbal vertebrae and (c and d) the cardiac mitral valve. Hematoxylin-eosin staining was used with enlargement of (a and c) 40 times and (b and d) 100 times. In (b), the proliferation of epithelioid cells (black arrow) and multinucleated datia Langhans (white arrow) were shown at the lumbar vertebra. In (d), the proliferation of epithelioid cells (black arrow) with caseous necrosis area (white arrow) and multinucleated datia Langhans (blackhead arrow) were also revealed at the mitral valve.
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The pathologic examination of the spinal tissue showed proliferation of epithelioid cells with multinucleated datia Langhans (Fig. 3a and b). The pathologic examination of mitral valve tissue showed proliferation of epithelioid cells with caseous necrosis area and multinucleated datia Langhans (Fig. 3c and d).
Vegetations appeared in the mitral valve during the surgery (white arrow).
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Multiple vegetation in the anterior mitral leaflet (AML) and PML (Fig. 4) were detected.
Timeline of the patient's medical history, present illness, treatment, and outcome.
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The summary of patient history can be seen in Fig. 5.