INFECTIOUS ENDOCARDITIS COMPLICATED BY SYSTEMIC SEPTIC EMBOLISM: CASE REPORT AND LITERATURE REVIEW

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0392

Abstract

Background: Infective endocarditis (IE) remains associated with a substantial burden of embolic complications. Septic embolization may precede the diagnosis, occur during antimicrobial therapy, or determine the indication and timing of surgery. The central nervous system and spleen are the classic embolic territories in left-sided IE, but the kidneys, mesenteric circulation, coronary arteries, and limbs may also be involved. Objective: To synthesize the clinical presentation, systemic embolic patterns, diagnostic tools, and therapeutic strategies described in case reports and case series of IE complicated by septic embolization, integrating these observations with contemporary evidence and guideline recommendations. Methods: A structured PubMed/MEDLINE search, supplemented by backward reference searching, was performed through September 1, 2026. Reports and series describing definite or highly probable IE with extracardiac embolization documented by imaging, surgery, or pathology were prioritized. Data on valve involvement, microbiology, embolic territory, echocardiographic features, antimicrobial therapy, interventions, and outcomes were extracted. Because of the intrinsic heterogeneity of case reports, a qualitative synthesis without meta-analysis was undertaken. Results: Published cases demonstrate a wide clinical spectrum, ranging from ischemic or hemorrhagic stroke as the first manifestation to simultaneous multiorgan embolization involving the brain, spleen, kidneys, mesentery, coronary arteries, and extremities. More aggressive patterns are repeatedly associated with large or mobile vegetations, Staphylococcus aureus, prosthetic valve endocarditis, unusual pathogens, and diagnostic delay. Transesophageal echocardiography and targeted or whole-body extracardiac imaging are central to staging disease extent. Recurrent embolization, uncontrolled infection, heart failure, or high-risk vegetations should prompt early multidisciplinary surgical assessment. Conclusions: Systemic septic embolization converts IE into a time-sensitive multiorgan disease. Outcomes depend on early microbiologic and echocardiographic diagnosis, active detection of embolic foci, appropriate antimicrobial therapy, source control, and timely valve surgery. Case-based evidence particularly highlights the need for individualized decisions in the presence of neurologic lesions, splenic abscess, mesenteric ischemia, or coronary embolism.

Keywords: infective endocarditis; septic embolism; systemic embolization; vegetation; stroke; splenic infarction; renal embolism; valve surgery.