An unusual cause of rigors and microscopic haematuria

Group B streptococcus is a rare cause of endocarditis that has been reported in infants or in association with systemic diseases such as diabetes, cancer, alcoholism, malnutrition, and immunosuppression.1 We know of only two previously reported cases of isolated pulmonary-valve endocarditis due to group B streptococcus in adults: in a 40-year-old malnourished alcoholic man,2 and a 61-year-old woman who presented after an episode of septic arthritis.3 Our case was notable for the selective involvement of the pulmonary valve in a previously healthy, immunocompetent patient. Surgical intervention is sometimes required for persistent infection, enlarging vegetations, or recurrent pulmonary emboli despite antibiotic therapy.4 Pulmonary-valve endocarditis commonly presents with non-specific features or respiratory symptoms due to septic emboli. Prompt introduction of appropriate antibiotic therapy can lead to rapid recovery, and prevent serious systemic complications and need for surgery, even in the presence of substantial pulmonary regurgitation and large vegetations.