Getting to the heart of the matter

Area of Science:

• Infectious Diseases
• Cardiology
• Neurology

Background:

• Infective endocarditis is a serious infection of the heart valves, often caused by bacteria.
• Streptococcus mitis, a common oral bacterium, can cause endocarditis, particularly in patients with pre-existing valve damage or poor dentition.

Observation:

• A 60-year-old woman presented with constitutional symptoms, weight loss, and neurological deficits.
• Physical examination revealed cachexia, poor dentition, and pyuria, initially treated as a urinary tract infection.
• Transesophageal echocardiography identified a large mass on the mitral valve, initially suspected to be an atrial myxoma.

Findings:

• Blood cultures grew gram-positive cocci, later identified as Streptococcus mitis.
• Cerebral magnetic resonance imaging confirmed multiple infarcts, indicative of embolic events.
• The mitral valve mass was confirmed to be vegetation secondary to infective endocarditis.

Implications:

• This case highlights the importance of considering infective endocarditis in patients with unexplained systemic symptoms and neurological events.
• Early diagnosis through blood cultures and echocardiography, followed by appropriate antibiotic therapy and surgical management, is critical for favorable outcomes.
• Streptococcus mitis should be recognized as a potential pathogen in infective endocarditis, even in the absence of typical risk factors.