We present the case of a 77-year-old woman with infective endocarditis due to methicillin-sensitive Staphylococcus aureus. Transesophageal echocardiography revealed a very large mobile vegetation with a tail-like appearance (Fig. 1). It grew from the internal wall of the left atrium adjacent to the anterior commissure and caused severe mitral valve insufficiency. Daptomycin and cloxacillin were started and the patient underwent mitral valve replacement. The mass was excised completely together with the mitral valve. Macroscopical examination showed an 8cm-long purulent lizard's tail-shaped growth (Fig. 2a and b). Anticoagulation was started on day 3 after surgery but was interrupted due to evidence of intracranial hemorrhage. On day 37, the patient was transferred to the general ward without neurological sequalae and subsequently discharged home without further complications.

Figure 1

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Figure 2

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