Infective endocarditis caused by Streptococcus pneumoniae from sinusitis: A case report

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Pneumococcal endocarditis (PE) is a rare complication of Streptococcus pneumoniae infection.
• The advent of pneumococcal vaccination has further reduced the incidence of PE.
• PE can present atypically and is associated with high mortality if not diagnosed and treated promptly.

Observation:

• A 71-year-old male presented with back and ankle pain, elevated inflammatory markers, and suspected infective endocarditis (IE).
• Transthoracic echocardiography revealed aortic valve vegetation, and blood cultures identified Streptococcus pneumoniae.
• Further investigations revealed a spinal abscess and maxillary sinusitis, with sinusitis identified as the likely source of infection.

Findings:

• This case represents the first reported instance of PE originating from sinusitis following pneumococcal vaccination.
• The patient was diagnosed with IE based on Duke's criteria and initiated on antibiotic therapy.
• Imaging confirmed an erector spinae abscess and bilateral maxillary sinusitis.

Implications:

• IE should be considered in the differential diagnosis for patients with S. pneumoniae bacteremia, even in the absence of pneumonia or after vaccination.
• Sinusitis can be an occult source of PE, highlighting the importance of thorough investigation.
• Early diagnosis using echocardiography and prompt treatment are vital for managing PE and preventing fatal outcomes.