eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-04-29 9 8 411 413 10.12691/ajmcr-9-8-7 AJMCR2021987 article Madiha Iqbal madiha.iqbal18@gmail.com 1 Bushra jamil 2 Marium Khurshid 2 Fatima Anam Farooqi 3 Chief Resident, Internal Medicine, Aga Khan University Hospital Professor Medicine, Aga Khan University Hospital Senior Resident, Internal Medicine, Aga Khan University Hospital Infective endocarditis remains an important clinical condition which if not picked and treated at time leads to devastating course. We present a case of middle aged female with prolong illness of around 2 months , developed devastating septic complications of infective endocarditis and underwent surgical resection of unusually giant vegetation with mitral valve replacement along with antibiotic treatment showed recovery soon after surgery, although her Blood cultures and tissue cultures remained negative. This case is of major interest that she was early recognized for all possible complications of the disease and treated accordingly with difficult surgery despite of prolong illness and complications. http://pubs.sciepub.com/ajmcr/9/8/7/ajmcr-9-8-7.pdf IE vegetation culture negative