Infective Endocarditis, A Nidus for Blood Stream Infection and Vertebral Osteomyelitis. Case Report with Literature Review

Infective endocarditis (IE) is a life-threatening infection of the endocardial surface of the heart, most commonly affecting the heart valves. It is a complex clinical entity characterized by a wide spectrum of presentations, evolving epidemiology, and a broad range of potential complications. While IE traditionally manifested in patients with pre-existing valvular disease, recent data highlight a shift toward healthcare-associated and device-related infections, often caused by Staphylococcus aureus, particularly in older adults and individuals with prosthetic heart valves or indwelling intravascular devices.

This case-based review discusses a rare but serious complication of IE—vertebral osteomyelitis—arising from hematogenous seeding of the spinal column by bacteremia. The patient, a 69-year-old female with multiple comorbidities and prior untreated Staphylococcus aureus bacteremia, presented with altered mental status and was later diagnosed with mitral valve IE complicated by vertebral osteomyelitis. Diagnosis was confirmed using transesophageal echocardiography and supported by magnetic resonance imaging findings.

This article emphasizes the diagnostic challenges and clinical implications of subacute infective endocarditis, particularly when classic signs are absent. It underscores the necessity of maintaining a high index of suspicion for metastatic infections such as vertebral osteomyelitis in patients with persistent bacteremia. The revised 2023 Duke-ISCVID diagnostic criteria and a multidisciplinary approach involving infectious disease and cardiology consultation are central to effective management. Early detection and prolonged intravenous antimicrobial therapy can prevent further complications and improve patient outcomes.