[Multivalvular infective endocarditis with Enterococcus faecalis]

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining, often presenting diagnostic and therapeutic challenges.
• Polyvalvular IE, affecting multiple heart valves, is an uncommon manifestation requiring careful consideration.

Observation:

• A 60-year-old patient with psychiatric comorbidities presented with severe IE caused by Enterococcus faecalis.
• Diagnosis was complicated by polyvalvular vegetations, septic multivisceral complications including splenic abscess, and unclear initial presentation.
• Echocardiography and blood cultures were crucial for diagnosing IE, while abdominal ultrasound revealed splenic abscess.

Findings:

• Despite aggressive antibiotic and symptomatic treatment, the patient experienced clinical deterioration.
• Death occurred due to irreversible toxic-septic shock, underscoring the severity of disseminated infection.
• The case was notable for polyvalvular involvement, specific pathogen, altered immune status, and extensive septic complications.

Implications:

• This case emphasizes the diagnostic difficulties and poor prognosis associated with complex IE, particularly in immunocompromised patients.
• It highlights the importance of early and accurate diagnosis through imaging and microbiology for effective management.
• The challenges in treating disseminated IE underscore the need for further research into novel therapeutic strategies.