Unusual Case Report of Infective Endocarditis Due to Streptococcus Agalactiae in Lebanon

Right-sided infective endocarditis caused by Streptococcus agalactiae is a very rare case. It may be complicated by right-sided heart dilatation leading to right-sided heart failure.Treatment guidelines on infective endocarditis caused by this agent remain limited, prompting further study to establish definitive treatment guidance. Surgical approach and antibiotic treatments remain the empirical treatment choice.

Right-sided infective endocarditis (IE) is uncommon. Furthermore, Streptococcus agalactiae (S agalactiae) rarely causes IE, with only 2% to 9% of bacteremia cases manifesting as endocarditis.

A 30-year-old Lebanese woman presented to the emergency department with high-grade fever and chills. Blood tests were obtained, urinalysis showed leukocytes, and treatment for urinary tract infection was initiated. The patient was hospitalized 3 days later and transferred to the ICU. Echocardiography revealed severe right-sided cardiomegaly, flail tricuspid leaflets with ruptured chordae, and a large coaptation defect. She was diagnosed with right-sided IE due to S agalactiae and underwent tricuspid valve replacement. Unfortunately, the patient died from acute decompensated heart failure.

This case represents an unusual instance of right-sided IE due to S agalactiae in Lebanon, for which definitive treatment guidance remains limited.