title: Native triple-valve endocarditis caused by penicillin-resistant Streptococcus sanguis.
abstract: BACKGROUND
  A 26-year-old man with known but untreated ventricular septal defect was admitted to the emergency ward with abdominal pain, fever and weight loss. Transthoracic echocardiography showed multiple vegetations on the anterior mitral leaflet, a mobile vegetation on the surface of the aortic noncoronary cusp and another on the tricuspid valve. His blood cultures grew Streptococcus sanguis with a penicillin minimum inhibitory concentration of 3 microg/ml.
  
  
  METHODS
  Physical examination, echocardiography, blood cultures, minimal inhibitory concentration detection.
  
  
  METHODS
  Multivalvular infective endocarditis caused by S. sanguis with a high penicillin resistance.
  
  
  RESULTS
  A combination of intravenous vancomycin and gentamicin, followed by early surgery.
authors.affiliation: Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey. isilbavunoglu@gmail.com
authors.forename: Isil
authors.initials: I
authors.lastname: Bavunoglu
authors.forename: Serap
authors.initials: S
authors.lastname: Sahin
authors.forename: Mesut
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Tayfur
authors.initials: T
authors.lastname: Toptas
authors.forename: Fehmi
authors.initials: F
authors.lastname: Tabak
authors.forename: Aydin
authors.initials: A
authors.lastname: Tunckale
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006801:Humans; D008297:Male; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013298:Streptococcus sanguis