Unusual presentation of infectious Endocarditis: case report

Abstract

Infectious Endocarditis is the involvement of the endocardium and mainly the heart valves by germs that, when multiplying, form vegetation. Its presentation is heterogeneous and varies from non-specific symptoms such as fever, weight loss and anemia to local and systemic complications such as intracardiac abscess, atrioventricular block, heart failure, acute myocardial infarction, pericardial effusion, distant embolic phenomena, and renal failure, among others. The diagnosis is made using the Duke-ISCVID 2023 Criteria, which classifies it as a definitive or possible diagnosis. Treatment involves intravenous antibiotic therapy for at least four weeks following the negative blood culture result. On some occasions, a surgical approach is necessary. Even with all established efforts, mortality remains high and is dependent on the etiological agent, the delay in diagnosis and the delay in starting treatment. This report addresses the case of a 57-year-old patient, treated in an emergency department, with rare complications of infective endocarditis (myocardial infarction due to septic coronary embolism and purulent pericarditis with echocardiographic signs of cardiac tamponade). Both blood cultures and pericardial fluid cultures grew Enterococci sp, typical of infective endocarditis. Right and left coronary angiography with left ventriculography and transthoracic echocardiography were essential tools to clarify this case.