A Cryptic Septic Endocarditis and Systemic Thromboembolism Triggered by Oral Microflora

Streptococcus Anginosus group is normal commensal flora of oral and gastrointestinal cavity. Being a commensal, it can provoke endocarditis only in the presence of defective, injured or congenital abnormal heart valve and predisposing factors like cancer, immunosuppression, and surgery. We present a rare of clinical case of aortic valve endocarditis with Streptococcus Anginosus in the 30-yr-young male with no recognizable risk factors and pre-existing cardiovascular disease. His clinical presentation was very vague with nausea, vomiting, memory impairment and upper respiratory symptoms. His aortic valve endocarditis gave rise to systemic embolism in the spleen, which spawned multiple splenic infarctions. Blood culture was positive for gram-positive rods and chains, most likely Streptococcus Anginosus, due to which he was treated with Pencillin G. Ultimately, he needed an aortic valve replacement with a prosthetic valve. This case highlights the rare case of bacterial endocarditis triggered by commensal microbial flora in absence pertinent risk factors.