REPORT OF A CASE
A 29-year-old man was admitted to the hospital, complaining of progressive weakness, chills, headache, nausea, and vomiting. On admission, he was cyanotic and in moderate distress. Cardiac examination disclosed a laterally displaced apex beat, a powerful right ventricular parasternal lift, and a loud pulmonary component of the second heart sound. All peripheral arterial pulses were decreased. Other significant findings included asymptomatic yellow papules on the neck and lower abdomen (Fig 1) and abnormal findings on fundus examination (Fig 2). He had been well until three years previously, when he developed progressive dyspnea on exertion and paroxysmal nocturnal dyspnea.Chest roentgenogram showed an enlarged cardiac silhouette with prominent central and pulmonary arteries, consistent with pulmonary arterial hypertension. Echocardiography showed enlargement of all chambers and extensive calcification of the left ventricular and left atrial endocardium. Computed tomographic scans confirmed the presence of calcifications in the endocardium (Fig 3,