Mitro-aortic infective endocarditis on bicuspid aortic valve multicomplicated: a case report

Infective endocarditis (IE) is a rare but serious disease, and despite improvements in diagnostic and therapeutic tools, it remains associated with high mortality. It can develop in a healthy heart, but most commonly in underlying heart disease. The authors discuss a 34-year-old patient, who has presented for 4 months with generalized asthenia, fever, and chills, without any notion of chest pain, arthralgias. On admission, the patient was conscious, hemodynamically, and respiratory stable, the temperature was 38.5°C. The cardiac exam heart revealed a systolic murmur rated 4/6th at the mitral focus. Transthoracic echocardiography showing vegetation on the mitral and aortic valve. Three blood cultures were taken at 1 h intervals, all positive for enterococci, thoracoabdominal and brain computed tomography scan with contrast injection was performed showing, ischemic stroke, aortic coarctation, splenic and renal infarction, mycotic aneurysms in the descending aort. IE can be the cause of several extracardiac manifestations, through vascular and/or immunological phenomena. Embolic complications are the most frequent extracardiac complications and are secondary to septic emboli from the vegetations. The prognosis of IE is worsened by the addition of cardiac and extracardiac complications such as mycotic aneurysms and septic embolic events.