Psoriatic arthritis

A 53-year-old man with psoriatic arthritis receiving monthly subcutaneous secukinumab treatment, moderate alcohol consumption up to a year prior to admission, and myoepithelioma in his right axilla and arm, underwent two surgeries, the first two years ago and the second one a month before the current admission. He experienced a few feverish peaks during the most recent intervention while being treated at the general surgery unit but no other accompanying symptoms. After obtaining three blood cultures, ciprofloxacin-based empiric antibiotic therapy was started. The physical examination revealed rhythmic heart sounds, ejective aortic murmur II/VI, and a protomesodiastolic aortic murmur, in addition to the absence of heart failure symptoms. In addition, a double moderate lesion of the bicuspid aortic valve (BAV) was confirmed (fig.1). Further histopathological examination(fig.2) confirmed the diagnosis as Infective endocarditis.