Atypical case of infective endocarditis

A man in his late 40s presented to the emergency department with generalised tiredness and breathlessness. He was a known case of chronic obstructive pulmonary disease and also had a recent history of COVID-19. At arrival, he was in respiratory failure. Blood culture grew Streptococcus parasanguinis, a commensal gram-positive bacterium and a primary coloniser of the human oral cavity. Echocardiogram revealed the presence of a flail mitral valve with vegetation suggestive of infective endocarditis. Although biomarkers of inflammation/infection had improved, he continued to be in cardiac failure, and hence he underwent mitral valve replacement with a mechanical valve. This case is unique in many ways; the patient was young, had a history of COVID-19, had native valve infective endocarditis and presented with type 2 respiratory failure and not the usual ‘typical’ manifestations of infective endocarditis. He had refractory heart failure requiring early valve replacement. His blood culture grew S. parasanguinis, a rare cause for infective endocarditis.