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Recurrent endocarditis of a bicuspid aortic valve due to Q fever

Cardiac Surgery Department, Free University of Brussels-ULB, Route de Lennik 808, B-1070 Brussels, Belgium

*Corresponding author. Tel.: +32 2 555 38 17; fax: +32 2 555 66 52.

E-mail address: ahmad_sabry_cts{at}yahoo.com (A.S.E. Ramadan).

A 46-year-old man was referred to our institution for a recurrent endocarditis with negative blood culture. Clinical examination and complementary investigations confirmed the diagnosis of aortic valve endocarditis with left ventricular fistula. Blood culture was negative but serological tests were positive for Coxiella burnetti. Aortic valve replacement and fistula repair were done. A combination of Doxycycline and Chloroquine antibiotics was given postoperatively with a clinical improvement. Coxiella burnetti should be systemically searched for in all cases of endocarditis even with negative blood cultures. This case is interesting because of its rarity, diagnosis, therapeutic problems and its severe complication.

Key Words: Q fever; Endocarditis; Fistula; Aortic root