Infective endocarditis presenting as bilateral ocular choroidal ischaemia and acute visual loss

Area of Science:

• Ophthalmology
• Cardiology
• Infectious Diseases

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves.
• Ocular complications can occur in IE but are often associated with specific findings.
• Diagnosing IE can be challenging, particularly in atypical presentations.

Purpose of the Study:

• To highlight a difficult case of infective endocarditis.
• To emphasize the diagnostic challenges posed by atypical ocular manifestations of IE.
• To underscore the importance of clinical suspicion in diagnosing IE.

Main Methods:

• Case report presentation.
• Review of clinical findings and diagnostic workup.
• Correlation of ophthalmological and cardiac evaluations.

Main Results:

• A case of infective endocarditis was diagnosed following bilateral ocular choroidal infarction.
• The diagnosis was made in the absence of typical signs such as retinal vasculitis, embolic phenomena, or clear cardiac symptoms.
• The patient's visual loss was the primary presenting complaint leading to the IE diagnosis.

Conclusions:

• Infective endocarditis can present with subtle or atypical symptoms, including profound visual loss.
• Ocular choroidal infarction can be a presenting sign of infective endocarditis.
• A high index of clinical suspicion is essential for the timely diagnosis and management of infective endocarditis, even in the absence of classic indicators.