Pneumococcal Endocarditis in a 49-Year-Old Male With Concomitant Myocarditis, Septic Spinal Arthritis, and Paraspinal...

Pneumococcal infective endocarditis (PIE) is a rare but serious infection often presenting with systemic complications such as septic emboli, myocarditis, and septic arthritis. This case report highlights a 49-year-old male who presented with acute-on-chronic lower back pain and fever, later diagnosed with PIE complicated by septic spinal arthritis, paraspinal myositis, and developing myocarditis. A 49-year-old male presented to the emergency department (ED) with worsening back pain and fever after treatment failure for suspected pyelonephritis. Laboratory studies revealed leukocytosis, hypercalcemia, and acute kidney injury, while magnetic resonance imaging (MRI) identified septic facet arthritis and abscess formation. A transesophageal echocardiogram (TEE) revealed aortic valve vegetations consistent with infective endocarditis (IE). The patient required aortic valve replacement and prolonged hospital stay due to sepsis and respiratory failure. He recovered within 12 weeks with only moderate residual heart failure symptoms. This case highlights the medical complexities and difficulties of treating IE, as well as the critical importance of having it on a wide differential due to increased morbidity and mortality with delay of diagnosis, antibiotics, and surgical intervention.