PMC9884818_01
A mobile structure (arrow) visualized in the pulmonary valve from trans-gastric view on transesophageal echocardiogram. The structure moved with the valve, well attached to the leaflets.
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PMC9884818_01_fped-10-1093300-g001.jpg
F1
To further confirm the diagnosis of IE, transesophageal echocardiogram revealed a mobile structure, well attached to and moved with the pulmonary valve leaflets, concerning for a pulmonic valve vegetation (Figure 1).
(A) Light microscopy demonstrated increased mesangial cellular and matrix expansion (arrow) as well as endocapillary hypercellularity (arrowhead) with scattered neutrophils within capillary lumens. (B) Electron microscopy revealed focal foot process effacement, subendothelial deposits (D). There were also multiple mesangial deposits (not shown) but no subepithelial deposits noted.
fped-10-1093300-g002.jpg
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F2
The pathological diagnosis was diffuse proliferative immune complex-mediated glomerulonephritis (Figure 2).