Infective Endocarditis Presenting as Acute Renal Failure and Unusual Complications

Infective endocarditis can be a diagnostic challenge. Few cases have so far reported infective endocarditis presenting as renal failure. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa and splenic abscess are rare complications of infective endocarditis. We herein report a case of an 80-year-old man admitted due to anorexia, malaise, edema of the legs and renal failure. A progressive degradation of the patient's renal function was documented and hemodialysis was started. Blood cultures revealed the presence of Enterococcus faecalis, and the patient was treated with ampicillin and gentamicin. The transesophageal echocardiogram findings showed pseudoaneurysms of the mitral-aortic intervalvular fibrosa and in the aortic root wall. Due to abdominal pain, an abdominal CT scan was performed and showed a cystic lesion compatible with splenic abscess. The patient received 6 weeks of antibiotic treatment. There was progressive clinical improvement and regression of the splenic abscess, but no recovery of the renal function. This report illustrates an unusual clinical presentation of infective endocarditis with unusual complications that were successfully treated with antibiotics.