Enterococcus faecalis aortic valve infective endocarditis in the third trimester of pregnancy presenting with septic cerebral emboli

A woman in her 30s, with a background of ulcerative colitis with total colectomy and ileostomy, presented at 36 weeks gestation with headache and transient aphasia. Magnetic resonance imaging of the brain identified multiple cerebral emboli. Given her history of previous ischaemic stroke, she was commenced on dual antiplatelet therapy. She continued to deteriorate, developing fevers and tachycardia. Transthoracic echocardiogram revealed a large vegetation on her aortic valve, and the blood cultured Enterococcus faecalis (E. faecalis). The bacteraemia source was attributed to subacute bacteraemia secondary to a small bowel resection and parastomal hernia repair for closed loop bowel obstruction at 28 weeks. Following a large multidisciplinary team meeting, the decision was made for emergency caesarean section, followed by same day aortic valve replacement. The patient went on to have a placental abruption and had emergency surgery despite being on clopidogrel. She recovered well and was discharged on a prolonged course of antibiotics and lifelong anticoagulation.