A 64-year-old male patient was referred to the Internal Medicine Department of the Cardiology Department due to fever above 38.3 °C for more than 3 weeks without source after 5 weeks of study.
On admission, the patient was under treatment with gliclazide (1-1-1) and acarbose (1-1-1) to control type 2 diabetes mellitus, Atorvastatin (0-0-20 mg) as prophylaxis for hypertension control (5-150 mg acetylsalicylic acid, quina).
In addition to these pathologies, the patient had severe aortic valve stenosis along with moderate aortic insufficiency, which required valve replacement with bioprosthesis Mitroflow No. 23 in March of the year of admission.
Upon arrival of the patient at the Cardiology Department, a five-week fever episode was performed. The patient was asymptomatic and had a prosthetic valve. A transesophageal echocardiography ruled out the presence of empirical endocarditis and did not show functional vestibular dysfunction.
During the discharge, the patient undergoes periodic checks of body temperature. Four weeks later, a new elevation was detected. The patient came to our hospital and was admitted for a second time in the Department of Cardiology with a diagnosis of transophagic fever.
After admission, fever greater than 38.3 °C, peaks of up to 39 °C, blood pressure of 150/70 mm mercury, and a heart rate of 104 beats per minute are confirmed.
On physical examination, the patient is normal-colored and normoperfused, cardiac auscultation does not show murmurs, pulmonary auscultation with preserved vesicular murmur without evidence of roncus adenopathy or foci of infection crackling.
Additional tests corresponding to the study of fever of unknown origin according to protocol 7 were performed with a blood count of 14,000 leukocytes (70% neutrophils and 5% fallen) and 1371 g/dl hemoglobin.
Biochemistry showed normal renal and hepatic function with normal glycemia.
A peripheral blood smear was performed confirming the complete blood count without other pathological findings.
The chest X-ray showed no pathological data or changes with respect to radiographs corresponding to previous admissions.
A radiograph of the paranasal sinuses showed hypoplasia of the left frontal sinus.
The transesophageal echocardiogram did not show data of endocarditis, abscesses or fistulas, along with a normal functioning aortic prosthesis.
Subsequently, Ga67 scintigraphy was performed with no tracer deposits were observed in the toracoabdominal region.
To complete the study of fever of unknown origin, tumor markers (alphafetoprotein, CEA-II, Ca 19.9n Ca 125II, BR 27.29, total PSA, Ca15.3 negative antinuclear antibodies, enolase
Since admission, blood cultures are taken after taking a body temperature higher than 37.5 °C, being positive in the four that are performed for Leuconostoc spp., and antibiogram showing susceptibility to amoxicillin.
Due to the existence of bioprosthesis, the patient is treated for 8 weeks as if it were endocarditis, although there were no evident lesions with transesophageal echocardiography.
Periodic controls were carried out for 1 year since discharge, without fever or clinical data leading to suspicion of any complication or valve complications.
