Infective Endocarditis After a Splenectomy: A Complex Association

Infective endocarditis is a potentially life-threatening condition that can have grave cardiac and neurologic complications. Recognizing risk factors, such as the presence of Gram-positive bacteremia and cardiac devices, has improved early recognition and management. The spleen plays an important role in the immune response, helping protect the body from infection from various bacteria. However, there is a paucity of literature regarding post-splenectomy patients with cardiac devices and the risk of endocarditis in this population. We present a case of infective endocarditis as a late sequela post-splenectomy in a 60-year-old patient with a history of a dual-chamber pacemaker. The patient was initially found to have bacteremia after splenectomy with repeat transesophageal echocardiogram confirming a tricuspid vegetation. The patient ultimately required pacemaker extraction and a prolonged course of intravenous cefazolin. The clinical course was complicated by a septic pulmonary embolus.