A Unique Case of Tri-Valvular Serratia marcescens Infective Endocarditis Complicated by Innumerable Emboli

Serratia marcescens (S. marcescens) is a gram negative bacterium rarely associated with cases of infective endocarditis (IE). Involvement of three cardiac valves, as evidenced by echocardiography, is uncommon as well. S. marcescens IE and tri-valvular endocarditis have been rarely described in literature. We report a unique case of S. marcescens tri-valvular IE in a 42-year-old female with sudden altered mental status and no underlying structural heart disease complicated by embolic infarcts in both cerebral and cerebellar hemispheres, and a sub-arachnoid hemorrhage. To our knowledge, this is the first reported case of tri-valvular S. marcescens IE. We believe this report will add to the growing literature of rare bacterial IE and considering this in the differential in the right clinical scenario.