Infective endocarditis presenting as back pain

A 51-year-old healthy man presented to emergency department with complaints of severe low back pain for 3 days and 2-week history of low-grade fever. Because of persistent back pain with fever up to 38 ℃, we ordered contrast-enhanced abdominal computed tomography (CT) which showed a huge aortic thrombus at the level of aortic bifurcation. Transthoracic two-dimensional echocardiography showed a vegetation at anteromedial leaflet of mitral valve, and infective endocarditis (IE) was diagnosed. After long-term broad-spectrum antibiotics and arterial embolectomy with mitral valve replacement, he discharged uneventually. Early diagnosis and treatment of IE at emergency department may be the key to the better result.