Infective Endocarditis Presenting as Unexplained Iron Deficiency Anaemia: A Diagnostic Challenge

Infective endocarditis is a potentially fatal condition that can present with non-specific symptoms and rare hematologic manifestations, posing significant diagnostic challenges. We report a compelling case of a 67-year-old male with a history of type 2 diabetes, hypertension, and hyperlipidemia who sought medical attention for a five-month history of progressive iron deficiency anemia, accompanied by weight loss, fatigue, and vague constitutional symptoms. Initial extensive workup, including computed tomography of the thorax, abdomen, and pelvis, gastroscopy, colonoscopy, and transthoracic echocardiography, failed to identify an underlying cause. Despite these unrevealing results, persistent clinical suspicion for an occult process led to advanced cardiac imaging. Transoesophageal echocardiography and computed tomography coronary angiogram ultimately uncovered infective endocarditis, characterized by severe mitral valve regurgitation and trivial aortic regurgitation. Blood cultures concurrently confirmed Enterococcus faecalis bacteremia. The patient underwent urgent surgical intervention with mitral valve replacement and aortic valve repair, resulting in full resolution of his anemia and systemic symptoms. This case underscores the importance of maintaining a high index of suspicion for infective endocarditis in patients with unexplained iron deficiency anemia and non-specific complaints, even when preliminary cardiac imaging is normal. It highlights the pivotal role of advanced imaging modalities in securing a diagnosis and enabling timely, life-saving treatment.