Acute limb ischaemia as an initial presentation of Streptococcus viridans infective endocarditis: a case report

Streptococcus viridans, a group of alpha-hemolytic streptococci, is a part of the normal oral flora typically linked to dental caries, pericoronitis and subacute infective endocarditis affecting native heart valves. We present a case of subacute infective endocarditis caused by Streptococcus viridans in a healthy man presenting with aortic valve involvement, large vegetation, septic embolism and acute limb ischaemia. Though acute limb ischemia is not a common initial presentation, it is crucial to consider infective endocarditis in the differential diagnosis when it is associated with a febrile illness, since delayed diagnosis leads to catastrophic complications.