Article Text

Download PDFPDF
Missed case of fever of unknown origin during COVID-19 pandemic: patent ductus arteriosus endarteritis
  1. Akash Batta,
  2. Samman Verma,
  3. Prashant Panda and
  4. Yash Paul Sharma
  1. Cardiology, PGIMER, Chandigarh, India
  1. Correspondence to Dr Prashant Panda; prashantpanda85{at}


A 40-year-old woman presented with fever of unknown origin (FUO) for 2 months. Without a definitive diagnosis and having received multiple empirical antibiotics from outside without relief, she was referred to our centre. Cardiac auscultation was remarkable for a grade 3/6 continuous murmur in the upper left sternal border. Echocardiogram revealed a patent ductus arteriosus (PDA) and a 5×7 mm mobile vegetation at the pulmonary artery bifurcation. Blood culture grew Streptococcus mutans. Embolisation of the vegetation to the pulmonary circulation occurred after the start of intravenous antibiotics resulting in fever relapse. Antibiotics were continued for 6 weeks and the fever settled. She underwent device closure of PDA after 12 weeks and is currently doing fine. Infective endocarditis/endarteritis is an important differential in a patient of FUO. A thorough clinical examination is important in every case of FUO, gives an important lead into diagnosis and guides appropriate investigations to confirm it.

  • cardiovascular medicine
  • infections

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AB: Conceptualisation, methodology, investigation, supervision, original draft preparation, reviewing and editing. SV: Original draft preparation, reviewing and editing. PP: Conceptualisation, methodology, investigation, supervision, validation, original draft preparation, reviewing and editing. YPS: Supervision, reviewing and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.