Infective endocarditis caused by Alcaligenes faecalis complicated with skin lesions

A 40-year-old man presented with a 10-day history of fever (>38.5°C) and skin lesions. He had been referred for acute type A aortic dissection and had undergone a Bentall procedure with aortic valve replacement using a mechanical prosthetic valve six months ago. Transthoracic and transesophageal echocardiogram showed aortic valve vegetations. Additionally abnormal activity around the site of prosthetic valve implantation was detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Repeated peripheral blood cultures showed the presence of Alcaligenes faecalis. The diagnosis of prosthetic valve endocarditis (PVE) was established (1).