PMC7256654_01
TEE showing mid-esophageal four chamber view with vegetation on A2,P2.
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Trans esophageal echocardiogram revealed multiple highly mobile vegetations on the anterior and posterior leaflets, largest measuring 1.0 cm x 0.4 cm. (Fig. 1, Fig. 2) He was treated with intravenous vancomycin.
Elastic trichrome stain showing diffuse proliferative glomerulonephritis with moderate global hypercellularity due to proliferation of endogenous glomerular cells including endothelial cells and mesangial cells.
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There was background of chronic glomerulosclerosis with associated tubular atrophy/interstitial fibrosis, likely preceding recurrent acute event (Fig. 3).
Direct Immunofluorescence with granular staining for C3, mesangial and capillary loop patterns.
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Direct immunofluorescence study showed, immune complex deposits mainly IgA, IgM, C3, C1q (Fig. 4).
Electron Microscopy with subendothelial deposits (arrows) along a length of glomerular basement membrane.
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On electron microscopy, immune complex dense deposits were present along the capillary basement membrane (Fig. 5).