Introduction: Fever of unknown origin (FUO) is a challenging clinical syndrome which encompasses wide clinical scenarios and requires bright decision making. (1-3)

Case presentation: We present a case of a 53-year-old man who was hospitalized because of intermittent fever that lasted for two years. He underwent a huge specter of diagnostic procedures that excluded infectious, immunological, hematological and tumorous causes of a long lasting fever. Due to advanced cardiac imaging a suspected foreign body in the heart was visualized. Computed imaging, transthoracic echocardiography and cardiac catheterization revealed one linear metallic density that corresponds to a sewing needle localized in the right ventricular outflow tract (RVOT). Right ventricle was mildly dilated (3cm) and systolic function was slightly reduced (40%). After all examinations patient was presented to a cardiothoracic surgeon for a surgical removal of the needle. Even after psychiatric consultation it remained unknown whether the strange body in the heart was consequence of self-mutilation or an accidental event.

Conclusion: A needle in the heart is a comparatively rare event. It has been described in cases of self-mutilation in psychiatric patients, intravenous injection and puncturing with acupuncture needles. Surgical removal of a sewing needle is the treatment of choice, but psychiatric consultation is recommended.