PMC6535683_01
Magnetic resonance imaging (MRI) of the brain with and without contrast showing a 3.8 x 3.7 x 3.4 cm necrotic mass in the left frontal lobe highly suspicious for an abscess with vasogenic edema and compression of the left lateral ventricle.
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A subsequent magnetic resonance imaging (MRI) of the brain confirmed a 3.8 x 3.7 x 3.4 cm necrotic mass in the left frontal lobe with thick wall enhancement and intense central restricted diffusion with a 3 mm midline shift to the right - highly suspicious for an abscess with a necrotic tumor considered less likely - and leptomeningeal enhancement in the right parietal region that could be secondary to meningitis with meningeal metastasis considered less likely (Fig. 1).
Transthoracic echocardiogram (TTE) suggestive of a 1.5 x 1.0 cm loosely associated echogenicity on the atrial aspect of the posterior leaflet of the mitral valve, highly suspicious for a vegetation, with moderate regurgitation also noted (left = parasternal long axis view, right = modified apical three-chamber view).
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Aggregatibacter aphrophilus. A transthoracic echocardiogram (TTE) was suggestive of a large mitral valve vegetation consistent with endocarditis, but a transesophageal echocardiogram (TEE) showed a flail posterior leaflet with severe regurgitation but no clear vegetation (Fig. 2, Fig. 3).