Group G Streptococcus Infective Endocarditis Complicated by a Very Delayed Coronary Embolism

Embolic complications are common in infective endocarditis (IE) and can lead to mortality. Although most embolic events occur early, delayed embolization is an underrecognized phenomenon. Coronary embolism, although rare, can present as ST-segment elevation myocardial infarction and requires high clinical vigilance.

A patient with diabetes mellitus was admitted for finger tenosynovitis, and was subsequently diagnosed with aortic valve IE due to Streptococcus dysgalactiae. There was residual vegetation despite antibiotics. The patient declined surgery, represented 6 months later with chest discomfort, and was diagnosed with an inferior ST-segment elevation myocardial infarction, likely due to a coronary embolic event.

Early surgical intervention in patients with residual vegetation is important to mitigate embolic risks. Embolic events can give a delayed presentation requiring high clinical vigilance.