Eustachian valve endocarditis: Its presentation and clinical characteristics

A 25-year-old female with history of intravenous drug abuse and tricuspid valve endocarditis presented for evaluation of recurrent endocarditis. Transthoracic echocardiography followed by transesophageal echocardiography revealed vegetation on the eustachian valve and was without evidence of vegetation on the tricuspid valve. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. She was treated with six weeks of intravenous antibiotic therapy but ultimately required tricuspid valve replacement due to severe tricuspid regurgitation. One month later, the patient was found to have bilateral septic pulmonary emboli. We report this rare finding of Eustachian valve endocarditis and review similar previously reported cases in the literature. <Learning objective: To be aware of the rare presentation of Eustachian valve endocarditis, its risk factors, workup, and management.>.