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Prosthetic Valve IE — RACP Adult Medicine MCQ

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ModerateCardiologyProsthetic Valve IERACP Adult Medicine

A 50-year-old man with prosthetic aortic valve presents with FUO for 6 weeks. He has splinter haemorrhages, a new aortic regurgitation murmur, and microscopic haematuria. Three sets of blood cultures grow Enterococcus faecalis. TOE shows a 10 mm vegetation on the prosthetic valve. What is the most likely cause of FUO?

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Correct answer: E — Infective endocarditis

Prosthetic valve with persistent fever, embolic phenomena (splinter haemorrhages), new regurgitation murmur, positive blood cultures (Enterococcus), and vegetation on TOE fulfils modified Duke criteria for definite IE (2 major + 1 minor criterion). Prosthetic valve endocarditis is a classic cause of FUO. Treatment: 6 weeks IV antibiotics (ampicillin + gentamicin for Enterococcus) with surgical assessment.

Reference: eTG Antibiotic – 2025 – IE; ESC 2023 IE Guidelines