Extract

A 41-year-old male was admitted to hospital after 15 days of unexplained fever. Four blood cultures were positive for Staphylococcus aureus. Echocardiography (Panels A and B) and magnetic resonance imaging (Panel C) showed a large thrombus in the left ventricle and a low ejection fraction and electrocardiogram (ECG) showed Q waves in anteroseptal leads. Coronary angiography documented an occlusion of the circumflex and transmural necrosis in the territories of the circumflex and the left anterior descending coronary artery were demonstrated by thallium myocardial scintigraphy. Labelled-leukocyte scintigraphy found a significant intra-cardiac fixation (Panel D).

The patient had no cardiovascular risk factors, and the main event in his history was a high-speed traffic accident in 1998, which resulted in rib fractures and bilateral pulmonary contusion. ECG at that time showed Q waves with negative T waves in the anteroseptal territory, ST-segment elevation lateral with a mirror in the inferior territory. No other cardiac investigations had been performed at that time.

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