rimary tumors of the heart are rare and are often classified histologically as 'benign'. One-sixth of these are papillary fibroelastomas, which usually originate in the heart valves. 1 A few previous reports have shown papillary fibroelastomas arising from the mural endocardium of the heart chambers, papillary fibroblastomas attached to the atrial septum are extremely rare. 2 Case ReportA 61-year-old woman was in good health until 2 months prior to admission to the Yamamoto General Hospital in June 1998. On admission she complained of progressive fatigue. The week before, she had had intermittent fever peaking at 39.5°C and 2 months prior she had had a tooth extraction.On physical examination, the patient was anxious, but did not appear to be ill. Her body temperature was 39.2°C, pulse rate was 84 beats/min, respiratory rate was 16 breaths/min and her blood pressure was 108/80 mmHg. The first and second heart sounds were normal with no gallop. A grade 2/6 mid-systolic murmur was heard at the apex. The lungs were clear on auscultation. The abdominal examination was unremarkable and the extremities showed no clubbing, edema, arthritis, Osler's nodes, or Janeway lesions. Neurological examination was unremarkable. Two-dimensional echocardiography showed a 5.0×1.5 cm heavy stick-like mass attached to the atrial septum, in the left atrium during ventricular systole and passing freely into the left ventricle in diastole. The head of the mass had a high-density echo that was thought to be vegetation (Fig 1) A 61-year-old woman had intermittent fever of 2 months' duration following a dental extraction. On admission, her body temperature was 39.2°C. A mid-systolic murmur was heard at the apex on ausculation. A 2-dimensional echocardiogram revealed a mobile, heavy stick-like mass with vegetation (5.0×1.5 cm) attached to the left atrial septum. Multiple blood cultures grew Streptococcus constellatus. On diagnosis of an infected left atrial myxoma, antibiotics were administered daily and 4 weeks later, the left atrial tumor was resected. The tumor was 5.3 cm long, 1.5 cm in diameter at the inter-atrial wall and had vegetation on the free edge. On microscopic examination, colonies of Gram-positive cocci were found in the thrombus, on the papillary fibroelastoma. After treatment with antibiotics for a further 4 weeks, the patient was discharged. This is the first report of infected papillary fibroelastoma.