The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient

Figures

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  Fig. 1. PET/CT Imaging of Whole-Body. (1) Postoperative bladder malignancy: The bladder shows reduced volume with low metabolic activity, with no definitive signs of tumor recurrence; (2) Multiple lymph nodes in the hepatic-gastric space, porta hepatis, bilateral inguinal regions, bilateral carotid sheath, clavicular, and bilateral axillary areas: Some of these lymph nodes are slightly enlarged with mild to moderate metabolic increase, which is more consistent with reactive lymphadenopathy; (3) Bilateral renal atrophy with faint imaging findings; (4) Age-related cerebral changes; (5) Multiple chronic inflammatory and calcified foci in both lungs, with small amounts of pleural effusion on both sides; (6) Multiple calcific lesions observed in the aortic valve, mitral valve, bilateral coronary arteries, thoracoabdominal aorta, and some branches; (7) Post bilateral knee joint replacement: Mildly increased metabolic activity in the synovial membranes; increased metabolism at the attachment site of the right ischial tuberosity and obturator internus muscle, suggesting inflammatory uptake

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  Fig. 2. Echocardiographic assessment of aortic valve function. (A) Two-dimensional echocardiography reveals mild aortic valve stenosis and incomplete valve closure (white arrow). (B) Color Doppler imaging demonstrates turbulent flow consistent with mild-to-moderate aortic stenosis

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  Fig. 3. Transesophageal echocardiogram (TEE) showing aortic valve vegetation. TEE reveals multiple irregular, high-density vegetations attached to the aortic valve and annular root (red arrows), with measured sizes of 0.29 × 0.26 cm, 0.51 × 0.35 cm, 0.81 × 0.25 cm, and 0.54 × 0.32 cm

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  Fig. 4. Daily maximum temperature trends and medication administration. High-Sensitivity C-Reactive Protein (hsCRP), Intravenous (IV), Next-generation sequencing (NGS), Every 8 h (q8h)