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A 59-year-old man with prosthetic mitral and aortic valves and an implantable cardioverter-defibrillator presented with a 1-month history of malaise and fever.
On presentation, the patient was febrile (38.5°C) with evidence of decompensated heart failure. The diagnosis of endocarditis was established as blood cultures grew streptococcus anginosus, and a transoesophageal echocardiogram on the second day of admission showed an 8 mm aortic valve vegetation and pacing …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; not externally peer reviewed.