case_images: PMC11304477_01
case_images: CT abdomen and pelvis with and without IV contrast showing acute bilateral renal infarcts (red arrows) with bilateral pyelonephritis.
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case_images: CT of the head did not find acute pathology, though his CT of the abdomen and pelvis was significant for acute bilateral renal infarcts with bilateral pyelonephritis, worrisome for septic emboli (Figure 1). Computed tomography angiography of the chest showed multiple pulmonary nodules with central cavitation suggesting septic pulmonary emboli (Figure 2), along with abscess and osteomyelitis involving the distal right first rib at the costochondral junction extending between the right first and second ribs.
case_images: CT chest angiography displaying multiple pulmonary nodules with central cavitation suggesting septic pulmonary emboli (red arrows).
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case_images: PMC11304477_01_10.1177_23247096241265917-fig2.jpg
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case_images: CT of the head did not find acute pathology, though his CT of the abdomen and pelvis was significant for acute bilateral renal infarcts with bilateral pyelonephritis, worrisome for septic emboli (Figure 1). Computed tomography angiography of the chest showed multiple pulmonary nodules with central cavitation suggesting septic pulmonary emboli (Figure 2), along with abscess and osteomyelitis involving the distal right first rib at the costochondral junction extending between the right first and second ribs.
case_images: TTE showing vegetations on pulmonic, mitral, and tricuspid valves.
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case_images: Transthoracic echocardiogram (TTE) revealed masses on 3 heart valves:a moderate sized vegetation (1.51 x 0.87 cm) on the pulmonic valve, a large and mobile vegetation (1.37 x 0.66 cm) on the posterior leaflet of the tricuspid valve, and a large mass (2.5 x 0.89 cm) on the anterior mitral valve (Figure 3).
case_images: MRI brain without IV contrast, using DWI (diffusion-weighted imaging) sequence, highlighting multiple acute infarctions compatible with septic emboli (red arrows).
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case_images: A magnetic resonance imaging (MRI) of the brain without IV contrast showed multiple acute infarctions compatible with septic emboli, as well as restriction of fluid diffusion in the occipital horns of lateral ventricles compatible with ventriculitis (Figure 4).
case_images: MRI cervical spine without IV contrast, using STIR (Short-TI inversion recovery) sequence, revealing discitis/osteomyelitis at C6-C7 level (yellow arrow) with a prevertebral fluid collection at C1-C4 (red arrow) concerning for epidural abscess.
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case_images: Magnetic resonance imaging of the cervical spine without IV contrast also revealed discitis/osteomyelitis at C6-C7 level with a prevertebral fluid collection at C1-C4 concerning for epidural abscess (Figure 5).