Enterococcus faecalis ( E. faecalis ) infective endocarditis (EFIE) is an increasingly recognized complication in immunocompromised patients, particularly those with malignancy. Cancer-related factors such as mucosal barrier injury, neutropenia, and frequent instrumentation predispose to bloodstream infections and subsequent endocardial involvement. Central nervous system (CNS) complications further complicate management and prognosis. We describe 2 cases of EFIE in patients with advanced malignancy and immunosuppression. The first case involved a 79-year-old male with metastatic gastric cancer and Merkel cell carcinoma who developed VSE aortic valve endocarditis complicated by embolic stroke and splenic infarct. Blood cultures identified E. faecalis originating from a prostatic abscess. He declined valve surgery and ultimately died of polymicrobial sepsis despite prolonged antibiotic therapy. The second case involved a 56-year-old male with acute myeloid leukemia and VRE mitral valve endocarditis. The diagnosis was complicated by neutropenia and CNS involvement, including meningitis confirmed by cerebrospinal fluid culture. He was successfully treated with high-dose daptomycin and ampicillin and stabilized for allogeneic stem cell transplant. These cases highlight the clinical variability of EFIE in cancer patients, including distinct routes of bacterial entry, CNS manifestations, and treatment considerations. VRE infections and CNS complications require aggressive combination therapy, while surgical decisions must be individualized based on immune status, bleeding risk, and cancer prognosis. EFIE in oncology patients demands a high index of suspicion, early imaging, and multidisciplinary coordination. Recognition of embolic complications and selection of appropriate antimicrobial regimens are essential to optimizing outcomes in this high-risk population.
Kornblum et al. (Fri,) studied this question.