Acute endocarditis is a rare complication of ulcerative colitis. We report on a young woman, who initially presented with fever, elevated inflammatory markers, and symptoms of ulcerative pancolitis but without any cardiac co-morbidity. A few days after total colectomy, the patient complained of acute abdominal pain which led to the suspected diagnosis of mesenteric ischaemia caused by a septic embolus. Transthoracic and transoesophageal echocardiography showed a large vegetation on the anterior leaflet of the mitral valve. The patient was successfully treated by an operative approach including mitral valve replacement.
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