Unusual location of aortic root abscess as a complication of bicuspid aortic valve infective endocarditis by a rare organism

A man in his 50s with diabetes, hypertension and history of multiple percutaneous coronary interventions presented with 3 weeks of fever and worsening shortness of breath. There was clinical suspicion of infective endocarditis with raised infective parameters. Transthoracic echocardiogram showed abnormally thickened, bicuspid aortic valve with suspicion of paravalvular aortic root abscess. Transoesophageal echocardiogram identified large vegetation on aortic valve and non-homogeneous area around the aortic root towards the right ventricular outflow tract, which was further confirmed as paravalvular aortic root abscess on cardiac CT. Blood cultures revealed a rare organism 'Burkholderia cepacia'. The patient responded well to intravenous antibiotics and surgical treatment with debridement of aortic root abscess, patch repair of aortic root and aortic valve replacement with a mechanical valve.