An unusual case of endocarditis.

A 74 year gentleman was admitted with a 6 month history of dizzy spells, malaise, generalised weakness and weight loss of over a stone. He attributed his weight loss to poor appetite due to persistent nausea. He had no significant past medical history apart from moderate mitral regurgitation and recent cholecystectomy. He felt some of these symptoms began after laparoscopic cholecystectomy 12 months before. The procedure had been complicated by a self-limiting biliary leak. He had been recently evaluated by chest physicians and gastroenterologists for clubbing and weight loss. Computerised tomography (CT) of the chest showed right basal fibrosis, CT of the abdomen and pelvis was normal, and upper endoscopy revealed a non-obstructive mild pyloric stenosis. Routine blood tests were unremarkable.