A 67-year-old man presenting with persistent high fever (>38degC) was admitted to hospital. He had a medical history of unoperated constrictive pericarditis, and several other complications such as previously surgery for Budd-Chiari syndrome, chronic hepatitis C infection and previous esophageal transection because of bleeding from esoph-ageal varices. Laboratory data showed leukocytosis (22,000/mul) and elevated C-reactive protein (32mg/dl). He immediately underwent whole-body computed tomography, which revealed only the known pericardial calcification (Figure 1). Furthermore, transthoracic echocardiography revealed no remarkable findings except for rapid atrial fibrillation and the known constrictive pericarditis. No obvious focus of infection was found. Multiple blood cultures were positive for methicillin-resis-tant Staphylococcus aureus (MRSA) and intensive intravenous antibiotic therapy was initiated to the unknown focus of the MRSA infection; however, his general condition gradually worsened and he died on hospital day 31 from uncontrolled MRSA infection and multi-organ dysfunction. We performed only a partial autopsy of his heart according to the wishes of his family.
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