[A classic example of infectious endocarditis?]

A 15-year-old girl in whom the diagnosis of infective endocarditis was established was sent to our cardiothoracic centre for mitral valve replacement because of a streptococcal endocarditis resistant to adequate antibiotic therapy. Despite the combination of fever, a 'new' heart murmur, 'positive blood cultures' and 'vegetations' on the mitral valve, the clinical picture gave rise to some doubt about the diagnosis. Finally the diagnosis of systemic lupus erythematosus was made and after treatment with corticosteroids all symptoms disappeared. In our modern era 'simple symptoms' still play a very important part in clinical decision making.