Urban trench fever presenting as culture-negative endocarditis.
Jenkins NE., Ferguson DJ., Alp NJ., Harrison TG., Bowler IC.
A young Russian man presented with increasing shortness of breath and signs of worsening aortic regurgitation. A diagnosis of infective endocarditis was made before emergency valve replacement. The infective cause was not discovered by routine culture but was suggested by electron microscopy and confirmed by serology and PCR testing.