A 65 year old man with a five month history of low grade fever, fatigue, and asthenia was admitted to our hospital. Physical examination findings were normal except for a grade III/VI systolic murmur at the apex. There was anaemia (6.3 mmol/l) with an elevated erythrocyte sedimentation rate (54 mm/hour). Blood cultures grewEnterococcus faecalis, and the patient was treated with penicillin and gentamicin for six weeks. Transthoracic and transoesophageal echocardiography demonstrated a vegetative mass in the aortic valve, a moderate aortic regurgitation, perforation of the anterior mitral leaflet, and a mitral valve aneurysm (LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle). Doppler examination revealed a moderate to severe mitral regurgitation across the mitral valve aneurysm. Because of mitral and aortic regurgitation and haemodynamic deterioration, the patient underwent aortic and mitral valve replacement. The aneurysm of the anterior mitral valve leaflet was confirmed during surgery. Histologic examination of the resected segments showed focal fibrin deposits and acute inflammation foci, consistent with the diagnosis of infective endocarditis. The postoperative course was uneventful and subsequent blood cultures were negative.

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