Infective Endocarditis with Large Papillary Muscle Vegetations in a Patient with HIV and Lymphoma: A Case Report

Isolated papillary muscle involvement in infective endocarditis (IE) is a rare occurrence.The authors report an unusual case of a 42-year man with human immunodeficiency virus (HIV) and B-cell lymphoma who had multiple vegetations on the mitral valve papillary muscles.The patient presented with nonspecific symptoms such as weakness, fever, and weight loss.Blood cultures revealed non-aureus staphylococcus species, and transthoracic echocardiography (TTE) identified large vegetations attached to the left ventricular papillary muscles.The patient refused further evaluation with transesophageal echocardiography (TEE) and left against medical advice.This case is notable for the isolated involvement of papillary muscles without other valvular apparatus involvement, a finding seldom reported in IE.This case underscores the need to consider IE in immuno-compromised patients with papillary muscle masses and the utility of TTE for early detection, while emphasising the need for advanced imaging and histopathological confirmation.