When Enterococcus faecalis becomes a murderer.

Area of Science:

• Cardiology
• Infectious Diseases
• Pathology

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves.
• Enterococcus faecalis is a common causative agent of IE.
• Systemic embolism is a known complication of IE.

Observation:

• A 64-year-old patient with a history of Enterococcus faecalis endocarditis on a biological aortic valve presented with recurrent bacteremia.
• The patient experienced cardiac arrest during hospitalization.
• Coronary angiography revealed acute left coronary artery occlusion.

Findings:

• Autopsy confirmed an Enterococcus faecalis thrombus on the aortic valve and left coronary artery.
• The case illustrates septic embolism to the coronary artery, a rare cause of acute coronary syndrome (ACS).
• This septic coronary embolism was the direct cause of cardiac arrest.

Implications:

• Septic coronary embolism is an unusual and potentially fatal complication of infective endocarditis.
• This case underscores the importance of recognizing rare presentations of IE complications.
• Early diagnosis and management of IE are crucial to prevent severe outcomes like ACS and cardiac arrest.