Severe XXXX due to @entity884 .

@entity1 @entity340 @entity375 @entity1353 @entity4 @entity2590 @entity338 @entity1503 @entity364 @entity358 @entity3218 @entity3219 @entity47 @entity1332 @entity166 @entity2059 @entity884
A 67-year-old @entity1 with @entity2590 , disseminated @entity3219 , and mitral valve replacement presented with @entity1353 and peripheral @entity4 . Transthoracic echocardiography demonstrated abnormal pulmonic valve with possible @entity47 . Color flow imaging showed laminar flow from main pulmonary artery into right ventricular outflow tract (RVOT) in diastole. The continuous wave Doppler signal showed dense diastolic envelope with steep deceleration slope. These findings were consistent with severe @entity338 , possibly due to @entity884 . Transesophageal echocardiography demonstrated an echodense mass attached to the pulmonic valve. The mitral valve bioprosthesis appeared intact. @entity1503 were negative; however, serum histoplasma antigen was positive. At surgery, the valve appeared destroyed by vegetations. Gomori @entity1332 silver-stains showed invasive fungal hyphae and @entity375 consistent with a dimorphic fungus. Valve cultures grew one @entity364 . @entity2059 was continued based on expert infectious diseases diagnosis. After surgery, @entity1353 and ankle @entity4 resolved. To the best of our knowledge, histoplasma @entity340 has not been previously reported. Isolated pulmonic @entity340 is rare, accounting for about 2% of @entity166 ( @entity166 ) cases. Fungi account for about 3% of cases of @entity340 . Characterization of pulmonary valve requires thorough interrogation with 2D and Doppler echocardiography techniques. Parasternal RVOT view allowed visualization of the pulmonary valve and assessment of regurgitation severity. As an anterior structure, it may be difficult to image with transesophageal echocardiography. Mid-esophageal right ventricular inflow-outflow view clearly showed the @entity338 . LEARNING POINTS: Identification and characterization of @entity358 require thorough interrogation with 2D and Doppler echocardiography techniques.Isolated pulmonary valve @entity166 is rare and requires high index of suspicion. @entity3218 @entity166 is rare and requires high index of suspicion.
