This is a 46-year-old male patient, unknown illness, with no history of drug addiction, with a 3-month subacute history of constitutional symptoms associated with hyporexia, asthenia and adynamia with involuntary weight loss of 8 kg. In addition, with evidence of quantified fever predominantly at night and progressive dyspnoea at rest associated with podalic oedema.

A transthoracic echocardiogram showed aortic endocarditis with a highly mobile aortic vegetation of 12 mm, severe aortic insufficiency, severe mitral insufficiency and congestive heart failure. A positive blood culture for penicillin-sensitive Streptococcus gallolyticus was documented, and antibiotic coverage was initiated. Among the laboratory studies, a computed axial tomography of the lumbar spine was performed, which showed hypodense areas in the spleen suggestive of infarction. In addition, a coronary catheterisation was performed, documenting an aneurysm in the right coronary artery of 8.3mm permeable, without lesions. The patient presented criteria for emergency surgery; however, due to the germ associated with this case, surgery was postponed in search of gastrointestinal neoplasia. On the eighth day of antibiotic treatment, the patient presented sudden deterioration of consciousness, the CT scan of the central nervous system showed right intraparenchymal haemorrhage, so he was taken to the operating room and a ruptured aneurysm of the right middle cerebral artery suggestive of mycotic aneurysm was documented, the haematoma was drained and clipped. The patient died two days after surgery.
