[Fever, negative blood culture findings and absence of response to antibiotic therapy in a patient after a second aortic valve prosthesis].
METHODS
A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.


METHODS
At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.


METHODS
Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.


CONCLUSIONS
Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.
Miljak
T
T
Medizinische Klinik I, Klinik am Eichert, Göppingen. miljak@t-online.de
Schmeiser
T
T
Hofgärtner
F
F
Sigel
H
H
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D016997:Coxiella burnetii / Q000276:immunology; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D005839:Gentamicins / Q000627:therapeutic use; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy; D011778:Q Fever / Q000175:diagnosis* / Q000188:drug therapy; D012008:Recurrence; D012086:Reoperation; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D005839:Gentamicins; D019980:Amoxicillin-Potassium Clavulanate Combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline