A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medical or family history. He had a low-grade pyrexia and cardiac auscultation revealed a diastolic murmur consistent with ‘tumour plop’. He had no sequelae of endocarditis. He had low-grade pyrexia of 37.7°C, and ECG showed sinus tachycardia at 130 bpm. He had raised inflammatory markers and was started on broad spectrum antibiotics. Blood cultures grew Streptococcus viridans twice. Transthoracic and transo-oesophageal echocardiography revealed a large mobile mass attached to the interatrial septum, suspicious for atrial myxoma, flopping into the left ventricle but not causing left ventricular outflow tract obstruction. All valves looked normal in appearance. He was treated with antibiotics for 2 weeks until inflammatory markers normalised. The patient was referred for cardiothoracic surgery where a large atrial myxoma (5 cm×3 cm) was excised just superior to the mitral valve. It had areas of necrosis and was colonised with S. viridans. He had an unremarkable postoperative course and made a complete recovery.
- cardiovascular medicine
- valvar diseases
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Contributors All of the authors named above have contributed to the diagnosis and management of the patient and were active in the authorship, research and proofing of the final manuscript. The case was planned with SA and he provided consultant oversight. GPF was involved in the day-to-day care and performed the TTE and TOE. ZS wrote a first draft and GPF and SA edited it. JJC got consent and explained the process to the patient as well as edited the images and did a literature review.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This article has been corrected since it was published online. Videos 1 and 2 have been edited in order to remove personal information about the patient.
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