A 38-year-old Sinhalese man presented to Teaching Hospital Kurunegala, Sri Lanka, complaining of a 3-week history of
fever; he was found to have a pansystolic murmur over the apex of his heart. He had
leukocytosis with predominant neutrocytosis. His
C-reactive protein was 231 mg/l and erythrocyte sedimentation rate was 100 mm/first hour. Transthoracic two-dimensional echocardiography revealed
prolapsed mitral valve with 7 × 13 mm vegetation over the posterior mitral valve. On the following day, three blood cultures became positive and were subsequently identified as Staphylococcus aureus. Intravenously administered
cloxacillin 3 g 6 hourly was started. Following day 24 of intravenously administered
cloxacillin, our patient developed high spike
fever. His total white blood cells were: 990/mm3 with 34% neutrophils and 22% eosinophils. His
hemoglobin concentration was 9.5 g/dL and platelet count remained normal (202 × 106/mm3). His
C-reactive protein was 78 mg/l, erythrocyte sedimentation rate was 95 mm/first hour, and he was otherwise comfortable, showing no signs of
sepsis beside the high grade
fever. His serum was negative for filarial and Toxoplasma
antibodies while stool was negative for oocytes and amoebic
cysts. Further, his serum was negative for dengue virus, Epstein-Barr virus, cytomegalovirus, and
hepatitis B antibodies. He was clinically well on day 6 after stopping
cloxacillin with 44% neutrophils and 18% eosinophils. His
C-reactive protein and erythrocyte sedimentation rate became normal, and there was no further plan for cardiothoracic intervention or administration of antimicrobials. He was discharged from hospital and remained well 6 months later.
CONCLUSION: