Triple-Valve Infective Endocarditis: A Case with Unusual Features

Infective endocarditis is a condition associated with high morbidity and mortality, usually with univalvular involvement. We describe the case of a 76-year-old woman with triple-valve endocarditis due to Streptococcus gallolyticus, complicated by perivalvular suppurative lesions, acute heart failure and acute kidney injury. Unfortunately, the patient died despite antibiotic therapy and emergent surgery. This case highlights uncommon triple-valve involvement in the absence of risk factors, posing a diagnostic and therapeutic challenge. LEARNING POINTS: Native triple-valve endocarditis is extremely rare, especially in the absence of predisposing conditions. Streptococcus gallolyticus has been associated with endocarditis as well colonic and hepatobiliary pathology, so gastrointestinal endoscopy is important as bacteraemia frequently precedes gastrointestinal symptoms, allowing prompt diagnosis. In multivalvular involvement, early surgery is often required, and timely recognition and treatment before complications develop may be decisive for prognosis.