Vegetation Stalagmite in Left Atrium

Abstract

Mitral valve prolapse (MVP) is a common disorder, occurring in 4% of the general population.1 It is associated with increased risk of infective endocarditis, and antibiotic prophylaxis is suggested in those high-risk patients who have systolic murmurs.2 The vast majority of cases involve the valve and its accessory apparatus. Herein, we present an unusual location of vegetation in a patient with MVP. A 45-year-old woman had been diagnosed with MVP 1 month before admission at our institution, after a grade III/VI pansystolic murmur with late systolic click was heard during a regular health checkup. Echocardiography illustrated myxomatous change and prolapse of the anterior mitral leaflet, with severe eccentric mitral regurgitation. Because of intermittent fever, left flank pain, and tender skin erythema of both feet, the patient visited our emergency department, where blood pressure 113/76 mm Hg, heart rate 126 bpm, and body temperature 39.5°C were noted. Blood analysis showed white blood cell count of 11 400/mm3, hemoglobin level of 9.7 g/dL, C-reactive …