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Atypical case of infective endocarditis
  1. Abraham M Ittyachen1,
  2. Ancy Peter1,
  3. Anjely Sukumaran1 and
  4. Joy Vinu2
  1. 1Department of General Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Kolenchery, Kerala, India
  2. 2Department of Cardiology, Malankara Orthodox Syrian Church Medical College and Hospital, Kolenchery, Kerala, India
  1. Correspondence to Dr Abraham M Ittyachen; abyliz{at}


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.

  • Adult intensive care
  • Valvar diseases

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  • Twitter @Abraham Ittyachen. M@abr_itt_m

  • Contributors AMI, AP and AS were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. AMI, AP, AS and JV gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.