⁎ Corresponding author at: Department of Anesthesia and Intensive Care, S. Maria dei Battuti Hospital, Via B. Bisagno 4, 31015 Conegliano (TV), Italy. Tel.: +39 0438663233; fax: +39 043864472. E-mail address: riccardo.carlon@ulss7.it (R. Carlon). Cervical cancer remains the second most common malignancy among women worldwide, although the widespread use of cervical cytology screening has led to a marked reduction in the incidence of the disease [1]. In 2007, a 43-year-old woman was admitted to S. Maria dei Battuti Hospital, Conegliano, Italy, with fatigue, dyspnea, and dry cough. Four weeks earlier she had undergone a Papanicolaou (Pap) test; 3 days after the procedure, she complained of lower abdominal pain and fever. Her primary-care physician ordered routine laboratory tests and prescribed amoxicillin–clavulanate (1 g twice daily for 6 days), some of the doses of which were missed (Table 1). Over the subsequent 2 weeks, her condition began to improve but then gradually worsened until she was admitted. Chest radiograph showed a right-sided pleural effusionwith an enlarged cardiac silhouette. Transthoracic echocardiography revealed a large floating vegetation attached to the anterior leaflet of themitral valve (3×1.84 cm). The patient rapidly became drowsy and hypotensive. She was admitted to the intensive care unit and intubated. Antibiotic therapy with oxacillin, gentamicin, and meropenem was started promptly. On the sameday, shewas transferred to a referral center for cardiac surgery and underwent mitral valve replacement with bioprosthesis. Four blood cultures were positive for Streptococcus agalactiae sensitive to penicillin G (minimum inhibitory concentration ≤0.12 μg/mL). The postoperative course was complicated by multiple spleen abscesses, stroke, and multiorgan failure, and the patient died. Colonization of the female genital tract with group B Streptococcus is common. Pap testing is a possible cause of transient bacteremia leading to endocarditis. A case of tricuspid endocarditis following routine Pap test has been reported [2] but, despite this, infective endocarditis is an extremely rare complication of the Pap test. S. agalactiae endocarditis is an aggressive disease that may result in rapid valve destruction. Surgical excision and valve replacement may be necessary [3]. Table 1 Results of patient's laboratory tests.