Unexpected

Cardiovascular System


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"The history of prolonged fever associated with a pansystolic murmur in the apex, early clubbing and splenomegaly strongly raises the suspicion of infective endocarditis (IE).\n\nHis blood cultures test positive for Streptococcus bovis (S. bovis), an organism well known to cause IE. In addition, his echocardiogram demonstrates an oscillatory mass attached to the mitral valve leaflet - most likely a cardiac vegetation. These findings are sufficient to confirm the clinical diagnosis.\n\nWhile many patients with IE have an obvious underlying etiology, at first glance, none is apparent in this patient. However, his full blood count (FBC) provides a hint by revealing the presence of microcytic hypochromic anemia.\n\nWhile IE itself may cause anemia (kn"}]}

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