A 54-year-old man was admitted for persistent fever (38 °C) after 15 days of appropriate antibiotic therapy for aortic endocarditis due to Streptococcus bovis . Clinical examination showed blood pressure 112/60 mmHg, a 2/6 diastolic murmur and arterial hyperpulsatility. Electrocardiogram and chest X-ray results were normal. White blood count cell was 14,000/mm 3 (80% neutrophils, normal eosinophil count) and C-reactive protein was 86 mg/L. Blood cultures were negative. Transoesophageal echocardiography showed two large aortic vegetations (12 and 14 mm), with severe aortic regurgitation but no abscess ( Fig. 1 A ). Secondary locations were searched to explain persistent fever: CT scan showed splenic infarction, cerebral MRI showed two left cortical ischaemic strokes and a cerebral abscess. Cerebral arteriography showed a mycotic aneurysm requiring cerebral embolization ( Fig. 1 B).
