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882 prosthetic mean gradient (83 mm Hg), indicat‐ ing valve obstruction. Transesophageal echocar‐ diography (TEE) showed mobile structures at‐ tached to the prosthesis, typical for bacterial veg‐ etations (Figure 1A) and inflammatory infiltration (22 × 8 mm) at the level of the non–coronary si‐ nus of Valsalva, involving the aortic and mitral curtain (Figure 1B). An evident perivalvular ab‐ scess or leak was not found. A 57 ‐year ‐old woman after 2 kidney transplants, chronically treated with immunosuppressive drugs (mycophenolate mofetil, tacrolimus), and after mechanical aortic valve replacement (AVR) (Medtronic Hall Easy‐Fit, Medtronic Inc., Minne‐ apolis, Minnesota, United States) 6 years earlier due to severe stenosis was admitted to the hospi‐ tal with recurrent fever, dyspnea on exertion, and elevated levels of inflammatory markers. Trans‐ thoracic echocardiography (TTE) revealed a high CLiNiCAL iMAge

Fatal course of perivalvular extension of infective endocarditis in a patient after aortic valve replacement treated with immunosuppressive drugs