Unusual case report of Streptococcus agalactiae infective endocarditis in Lebanon

Abstract

Background: Infective endocarditis (IE) uncommonly happens right-sided. Furthermore, Streptococcus agalactiae rarely causes IE, in which only 2-9% of bacteremia cases manifest as endocarditis. 

Case presentation: A 30-year-old Lebanese woman came to the emergency room (ER) with a high-grade fever and chills. Blood tests were drawn, urine analysis showed leukocytes in urine, and treatment for urinary tract infection was started accordingly. The patient was hospitalized three days later and transferred to the intensive care unit (ICU); severe right-sided cardiomegaly, flailed tricuspid leaflets with ruptured chordae, and large coaptation deflect were discovered during echocardiography. She was diagnosed with Streptococcus agalactiae right-sided infective endocarditis and underwent tricuspid valvular replacement. Unfortunately, the patient died after suffering from acute decompensated heart failure. 

Conclusion: This is an unusual S. agalactiae right-sided infective endocarditis case found in Lebanon, in which definitive treatment for IE caused by this agent is still limited.