Persistent fever in a multicomplicated infective endocarditis

摘要

A 54-year-old man was admitted for persistent fever (38 °C) after 15 days of appropriate antibiotic therapy for aortic endocarditis due to Streptococcus bovis. Clinical examination showed blood pressure 112/60 mmHg, a 2/6 diastolic murmur and arterial hyperpul-satility. Electrocardiogram and chest X-ray results were normal. White blood count cell was 14,000/mm3 (80% neutrophils, normal eosinophil count) and C-reactive protein was 86mg/L Blood cultures were negative. Transoesophageal echocardiography showed two large aortic vegetations (12 and 14 mm), with severe aortic regurgitation but no abscess (Fig. 1A). Secondary locations were searched to explain persistent fever: CT scan showed splenic infarction, cerebral MRI showed two left cortical ischaemic strokes and a cerebral abscess. Cerebral arteriography showed a mycotic aneurysm requiring cerebral emboliza-tion (Fig. 1B).