A Case of Infective Endocarditis Masquerading as Gastroenteritis: The Critical Role of Echocardiography in Diagnosis

By Huaxin Li^1,2

Affiliations

1. Department of General Surgery, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
2. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital (Affiliated Hospital of University of Electronic Science and Technology of China), Chengdu, China

doi: 10.29271/jcpsp.2025.10.1356

Sir,

Infective endocarditis (IE) with severe mitral regurgitation is a life-threatening condition, requiring urgent surgical intervention.¹ The author reported a case of 26-year female who presented with sepsis-like symptoms, was initially misdiagnosed with gastroenteritis, and later confirmed to have IE with mitral valve abscess.

The patient presented with a 7-day history of dizziness, fatigue, and headache, followed by fever and diarrhoea. Initial examination revealed fever (39°C), hypotension (85/55 mmHg), and elevated inflammatory markers. CT imaging showed pericardial thickening, splenomegaly, and a kidney stone, prompting further cardiac evaluation.

Transthoracic echocardiography revealed mitral valve vegetation, and transesophageal echocardiography confirmed severe mitral regurgitation with abscess formation on the posterior leaflet (P3 segment), necessitating surgical intervention. Blood cultures supported the diagnosis of IE.²

The patient underwent mitral valve replacement with a mechanical prosthesis and abscess debridement. Postoperatively, she was stabilised in the ICU and started on anticoagulation therapy. Follow-up echocardiography confirmed proper valve function with only mild tricuspid regurgitation.

This case underscores the importance of early cardiac evaluation in febrile patients, particularly when atypical symptoms such as diarrhoea are present.³ Echocardiography should be considered in young patients with sepsis-like symptoms to avoid misdiagnosis and delayed treatment of IE.

COMPETING  INTEREST:
The  author  declared  no  conflict  of  interest.

AUTHOR’S  CONTRIBUTION:
HL: Conceiving the idea for the article and drafting the manuscript.
The author approved the final version of the manuscript to be published.

REFERENCES

1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3^rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63(22):e57-185. doi: 10.1016/j. jacc.2014.02.536. Erratum in: J Am Coll Cardiol 2014; 63(22):2489.
2. Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44(39): 3948-4042. doi: 10.1093/eurheartj/ehad193.
3. AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153(6):1241-58.e29. doi: 10.1016/j.jtcvs.2016.09.093.