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Kidney biopsy images. (a) Glomeruli with cellular crescents, one of which also shows segmental necrosis (arrow). Periodic-acid Schiff. (b) Strong granular mesangial staining for C3 by immunofluorescence. (c) Weak granular mesangial staining for IgG by immunofluorescence. (d) Electron microscopy showing mesangial deposits (arrows) and (e) small subendothelial deposit (arrow).
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A kidney biopsy was done on day 3 of hospitalization (Figure 1).
Echocardiogram images showing vegetations (densities) on the aortic valve with severe aortic regurgitation (arrow shows the vegetations).
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A murmur heard on physical examination prompted transthoracic echocardiogram, which revealed linear densities on the aortic valve (Figure 2). A trans-esophageal echocardiogram confirmed the presence of vegetations on the aortic valve with severe aortic regurgitation (Figure 2). An infectious disease consultation was obtained, and additional tests were ordered for culture-negative endocarditis.