When Infective Endocarditis Masquerades as Gastrointestinal Disease: A Case Report

Infective endocarditis (IE) is a serious and potentially life-threatening condition characterised by inflammation and infection of the endocardium. While cardiac manifestations are well-recognised, extracardiac manifestations of IE, particularly in the gastrointestinal tract, are less commonly reported. We report the first known case of IE presenting with colitis-like symptoms in the absence of identifiable colonic pathology.

A 34-year-old male patient presented to primary care with gastrointestinal symptoms, including fever, weight loss, and bloody diarrhoea. There was an absence of detectable intestinal pathology on colonoscopy, and subsequent findings revealed a link between the gastrointestinal symptoms and IE-related complications. The patient later developed right-sided flank pain, a pansystolic murmur, and splinter haemorrhages in two fingernails. Imaging studies indicated renal infarcts suspicious for septic emboli, and echocardiography revealed severe mitral regurgitation with an anterior leaflet vegetation. Blood cultures were negative, likely due to prior antibiotic administration.

The patient was therefore treated with empirical intravenous antibiotics (amoxicillin, flucloxacillin and gentamicin), resulting in the resolution of gastrointestinal symptoms.

This case highlights the importance of considering IE in patients with unexplained gastrointestinal symptoms and systemic features, even in the absence of visible colonic lesions. Early recognition and appropriate management may improve outcomes.