Infective Endocarditis with S. Gordonii on Native Mitral Anterior Valve

We report the case of a 66-year-old male with a complex medical history, including grade 3 essential hypertension NYHA class II chronic heart failure with preserved LVEF and chronic ischemic heart disease. The patient was also diagnosed with ankylosing spondylitis, receiving biologic therapy with etanercept, type II diabetes mellitus and gout. The patient presented with a progressive aggravation of his chronic pathology three months anterior to hospitalization, characterized by significant physical asthenia, exertional dyspnea, anterior chest pain, tremor of the extremities, fever with chills and a syncopal episode. These symptoms prompted evaluation in the Cardiology Department of “St. Spiridon” Hospital, Iași, where the diagnosis of infective endocarditis (IE) involving the native anterior mitral valve was established.

The diagnosis was based on clinical presentation, laboratory investigations, echocardiographic findings, and the isolation of Streptococcus gordonii from blood cultures obtained during a febrile episode. Following diagnosis, the patient was referred to the “St. Parascheva” Infectious Diseases Clinical Hospital, Iași, for specialized antimicrobial therapy and further management. Notably, despite the patient’s immunocompromised state — attributed to diabetes mellitus and ongoing immunosuppressive therapy with a tumor necrosis factor (TNF) inhibitor—clinical progression was favorable.

This was evidenced by resolution of fever, a marked reduction in inflammatory markers and nitrogen retention parameters, and a stable echocardiographic profile at discharge. This case underscores the importance of early diagnosis and appropriate antimicrobial therapy in managing infective endocarditis, even in patients with multiple comorbidities and immunosuppressive conditions, thus highlighting the potential for non-surgical resolution in selected cases.