Infective endocarditis is less likely to sparkle out preferentially in our mind when evaluating and making differential diagnosis of fever patients daily in emergency department. We describe a case of infective endocarditis. He was initially diagnosed with pyelonephritis of right kidney at a hospital because of noted right flank knocking pain. His computed tomography showed two wedge shaped low density lesions in the spleen and right kidney, separately. It dropped a hint to the emergency department physician of thinking of feature of infarct. The previously neglected cardiac murmurs were then an important clue. We then performed transthoracic emergent echocardiography and confirmed the diagnosis of infective endocarditis.
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