A 57‐year‐old man presented with left facial droop and dysarthria due to a multiterritory ischaemic stroke affecting the right posterior and middle cerebral arteries. His previous history included a segmental pulmonary embolus in the setting of pneumonia. He was not taking any regular medications and denied recreational drug use. There was no relevant family history. He was haemodynamically stable, afebrile and euvolaemic. White cell count was normal at 7.8 × 109/L (reference interval [RI], 4–12 × 109/L). C‐reactive protein was mildly elevated at 9 mg/L (RI, < 5 mg/L). On day 1, transthoracic echocardiogram revealed a vegetation on the anterior mitral valve leaflet tip with moderate to severe mitral regurgitation, normal left atrial size and biventricular size and systolic function. Three sets of blood cultures were taken before commencing intravenous ceftriaxone and flucloxacillin. He was transferred to our hospital for surgical consideration.
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