A 48-year-old male teacher was admitted to thecardiology unit for evaluation of fever of 5 months’duration. The fever was low grade associated with chillsand night sweats but no rigors. There were no systemiccomplaints nor was any dental or other procedureperformed in the recent past. He was treated by manygeneral physicians with a variety of antibiotics andantimalarial but there was no sustained response. He wasadmitted to the general medical unit as a case of PUO andthoroughly investigated but except for raised Erythrocytesedimentation rate (ESR) nothing was positive. He wasempirically started on Oflaxacin infusion but his fever didnot respond. Later he was started on anti TB drugs butthere was no response upto one month. Steroids wereadded to the regimen but still no response.He had sustained a myocardial infarction in 1986 and1989 and had a Coronary artery bypass graft (CABG)done in 1993, and was doing well with it. He wasreevaluated in cardiology with a temperature of 100°F. Asystemic exam only revealed soft systolic murmur at theapex radiating to the axilla. All the investigations wererepeated and in addition echocardiography wasperformed which was not done before. All the laboratorytest was negative again, and the echo showed mitral valvevegetation. A diagnosis of possible infective endocarditiswas made and as the blood cultures were negative, he wasempirically started on Penicillin and gentamicin but therewas no response upto ten days. Echocardiography wasrepeated that showed an increase in the size of vegetationwhich was confirmed on transesophagealechocardiography (Fig-1). The patient was switched overto Ceftraixime, because of its better potency and broaderspectrum, l gram three times a day (TDS). On the 3rd dayhis fever began to respond and he felt better two weeksafter initiation of Cefotaxime, TEE was repeated showingcomplete resolution of vegetation. Treatment wascontinued for another week and on a follow up a monthlater he was found to have totally recovered and returnedto his job


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