Development of aortic valvular vegetations during appropriate antibiotic therapy. Demonstration through serial echocardiograms

The development of echocardiographically demonstrable vegetations on cardiac valves while the patient is receiving appropriate antibiotic therapy has not been previously reported. We report a case of alpha-hemolytic streptococcal endocarditis involving the aortic valve. Echocardiographically visualized vegetations were noted to occur on the 11th day of hospitalization. We discuss the role of serial echocardiograms in the management of patients with bacteremias and suspected endocarditis but absence of vegetations on the initial echocardiogram.