B50-28 From Valve to Vessels: A Case of MSSA Endocarditis With Widespread Embolic Events

Abstract Introduction Infective endocarditis (IE) remains a life-threatening condition, predominantly affecting individuals with specific risk factors, including intravenous drug use (IVDU). Methicillin-sensitive Staphylococcus aureus (MSSA) is a leading cause of IE. Embolic events are frequent complications, occurring in approximately 40% of cases, and can lead to infarctions in various organs, including the spleen, kidneys, and brain. Although mesenteric artery embolism is a less common manifestation, it can lead to bowel ischemia and aneurysm formation, which require prompt surgical intervention. This case underscores the complex interplay between IVDU-associated IE and its embolic complications, highlighting the necessity for a multidisciplinary approach for early recognition and emergent intervention to improve patients’ outcomes. Case Description A 43-year-old male with a history of intravenous drug use was brought to the hospital after being found unresponsive. He was diagnosed with MSSA bacteremia and aortic valve endocarditis, complicated by severe aortic insufficiency. His course complicated by embolic infarcts involving the spleen, bilateral kidneys, brain, and septic emboli to the superior mesenteric artery (SMA)(Image 1.1). The patient underwent emergent percutaneous SMA thrombectomy by Vascular Surgery. However, his condition progressed, leading to the development of a SMA aneurysm (Image 1.2). He subsequently required an open SMA repair with great saphenous vein bypass and a splenectomy. An MRI of the brain revealed septic emboli in the parieto-occipital regions, raising concern for mycotic aneurysms. A diagnostic cerebral angiogram was performed but did not identify any aneurysms. Once stabilized, the patient underwent aortic valve replacement with a bioprosthetic valve was discharged to a long-term rehabilitation center. Discussion This case highlights the severe complications associated with IVDU-related infective endocarditis, particularly due to MSSA. The high virulence of MSSA contributes to rapid disease progression, leading to severe valvular destruction, systemic embolization, and multi-organ involvement. Embolic events in IE occur in nearly 40% of cases; with brain, spleen, and kidneys as the most common affected sites(5). Septic embolization to SMA is a rare but serious complication as it can cause bowel ischemia, infarction, and aneurysm formation; often necessitates urgent surgical intervention. The presence of septic emboli in the brain raised concerns for mycotic aneurysms, which, while not detected in this case, remain a critical complication due to the risk of rupture and hemorrhage. Neurologic sequelae from IE-associated embolic strokes can significantly impact patient prognosis. Moving forward, addressing IVDU through comprehensive rehabilitation programs is essential in reducing the incidence of recurrent IE and improving long-term patient outcomes. This abstract is funded by: None