Malaise, fever, and nausea in a man with marfan syndrome

A 37-year-old male with Marfan syndrome was admitted to the hospital with several weeks of low-grade fevers and a 1-week history of fatigue and malaise. At age 21 years, he had a type A thoracic aortic dissection for which he underwent an aortic valve replacement with a St. Jude mechanical valve, and then at the age of 36 years, he was diagnosed with an abdominal aortic aneurysm dissection requiring a bypass graft repair. Extensive evaluation including transesophageal echocardiogram was unrevealing; however, his fevers resolved with empiric antibiotics. He was diagnosed with presumed culture-negative prosthetic valve endocarditis. Four weeks prior to the current presentation, he was discharged on intravenous ceftriaxone and vancomycin with oral rifampin.