Nonspecific Decline in an Elderly Female Revealing a Fatal Infective Endocarditis

We are presenting a case of an elderly female in her 70s who was admitted with extreme fatigue, acute confusion, and functional decline following a respiratory tract infection on the background of multiple complex comorbidities. Initial investigations revealed a chest infection. Therefore, blood culture was requested in view of her advanced age and initial high urea level, which came back positive for Staphylococcus epidermidis and the lab report initially considered it a contaminant sample. Further blood cultures were negative. However, she was deteriorating quickly despite proper sepsis cover, which warranted extensive investigations including transesophageal echocardiography (TOE), which revealed a native aortic valve vegetation with peri valvular involvement, confirming native valve infective endocarditis (IE). She was immediately transferred under multidisciplinary team (MDT); however, she failed to improve and died in the hospice a couple days after discharge. This case highlights the diagnostic challenge of IE, especially among frail elderly people who mostly presents with nonspecific symptoms, causing delayed diagnosis and fatal outcome.