A Twisting Tale of Infective Endocarditis

We present a case of a unique complication of enterococcus endocarditis in an elderly man with a cardiac pacemaker who presented with low-grade fever and cough. He had no history of IV drug use. Blood cultures were positive for Enterococcus faecalis, Both trans-thoracic echo and trans-esophageal echo showed vegetation on the aortic valve. He was discharged on adequate antibiotic coverage but later presented again with near syncope. On cardiac monitoring, he was found to have episodes of torsades. Unlike heart failure or peri-valvular abscess, torsades is a rare complication of endocarditis. We aim to present a case report of a rare complication of infective endocarditis (IE) which if not identified timely, can lead to lethal outcomes. Unfortunately, our patient did not survive, but we learnt that though rare, we should always anticipate rhythm problems such as torsades as complications of endocarditis and should promptly treat with magnesium and antiarrhythmic drugs such as lidocaine if needed.