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Streptococcus salivarius is a commensal bacterium of the oral and gut flora and is rarely implicated in infective endocarditis (IE). Herein, we present a case of a 69-year-old male who presented with fatigue, weight loss, and no fever, ultimately diagnosed with IE complicated by severe aortic regurgitation. Initial investigations revealed leukocytosis, anemia, hyperkalemia, and elevated troponins. Imaging studies revealed bilateral common iliac artery aneurysms and atrophic kidneys with renal cysts. Transthoracic and transesophageal echocardiograms revealed mobile aortic vegetation, severe aortic regurgitation, and valve perforation. Blood cultures identified Streptococcus salivarius/vestibularis. The patient underwent aortic valve replacement, resulting in clinical improvement and negative blood cultures. The discussion highlights the rarity of S. salivarius causing IE and emphasizes the challenges in management, including the need for timely surgical intervention and multidisciplinary care in complicated IE cases. This case underscores the importance of considering atypical pathogens in IE and the complexities involved in its diagnosis and management. Further research is warranted to elucidate such cases' clinical implications and optimal management strategies.
Antoine Egbe (Sat,) studied this question.