Unusual extracardiac manifestations of isolated native tricuspid valve endocarditis

Isolated native tricuspid valve endocarditis (TVE) in non-intravenous drug users is a very rare condition. We describe an unusual presentation of Enterococcus faecalis TVE associated with spondylodiscitis, positive cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase-3 antibodies vasculitic rash in an otherwise healthy patient with no history of intravenous drug use or underlying cardiac abnormalities. A high index of clinical suspicion is required in patients presenting with unusual features and pyrexia of unknown origin. Simple tests including serial blood cultures and echocardiography may help to establish the correct diagnosis and commence appropriate treatment.