[Uncommon diagnosis in a patient with fever and new-onset cardiac murmur].
METHODS
A 34-year old man was referred because of persistent low-grade fever and a newly-diagnosed systolic murmur. He complained of atypical chest pain and dyspnoea on exertion for the past few weeks.


METHODS
Blood analysis revealed an elevated CRP level (67.7 mg/l) along with a hypochromic, microcytic anaemia (Hb 122 g/l). Transthoracic echocardiography showed an extracardiac tumour compressing the right ventricular outflow tract. Computed tomography (CT) localized the tumour in the anterior upper mediastinum. Subsequently, a biopsy was carried out and revealed a non-seminomatous germ-cell tumour.


METHODS
The diagnosis having been made the patient received four cycles of chemotherapy according to the BEP-protocol (bleomycin-etoposide-cisplatin). The remaining tumour was then resected surgically. After additional cycles of chemotherapy two autologous stem cell transplantations were carried out.


CONCLUSIONS
This patient presented initially with symptoms typical of endocarditis. However, the reason for his newly diagnosed systolic murmur and persistent fever was an extracardiac germ cell tumor compressing the right ventricular outflow tract.
Osterwalder
R
R
Klinik für Intensivmedizin, Universitätsspital Basel. osterwalderr@bluewin.ch
Pless
M
M
Heierle
A
A
Aschkenasy
S V
SV
Koch
G
G
Sticherling
C
C
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004452:Echocardiography; D005335:Fever of Unknown Origin / Q000209:etiology*; D006337:Heart Murmurs / Q000209:etiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D020360:Neoadjuvant Therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis*; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D013599:Systole; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis*