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A 21-year-old, previously healthy man with excellent dentition presented with a two-week history of high-grade fever, chills, and malaise. On the fourth hospital day, an early decrescendo diastolic murmur was heard for the first time. The white-cell count was 10,600 per cubic millimeter, with 9 percent band forms. Transesophageal echocardiography revealed substantial aortic regurgitation and vegetations (arrows in Panel A) on a bicuspid aortic valve. The patient was treated with floxacillin and gentamicin before blood cultures yielded Haemophilus aphrophilus. On the eighth day, he had a red, fluctuant, painful swelling on his left foot at the metatarsal level (Panel . . . [Full Text of this Article] |
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