# An Unusual Presentation of an Enterococcus faecalis Endocarditis With Wrist and Forearm Infection: A Case Report

## TL;DR

This case report describes a rare instance of Enterococcus faecalis endocarditis presenting with wrist and forearm infection, highlighting the challenges in diagnosis.

## Contribution

The report presents an unusual clinical presentation of E. faecalis endocarditis with wrist and forearm infection.

## Key findings

- The patient was initially treated for gout and infections before E. faecalis endocarditis was diagnosed.
- Transesophageal echocardiography revealed valve vegetations and a mitral leaflet perforation.
- Antibiotic treatment was effective, and surgery was avoided due to lack of progression.

## Abstract

In this case, an unusual presentation of Enterococcus faecalis (E.faecalis) endocarditis and clinical signs of wrist and forearm infection are reported.

Before the patient was diagnosed with E.faecalis endocarditis, the patient managed to be treated with both prednisolone, various antibiotics, and colchicine on suspicion of gout, erysipelas, and deep tissue infection. Growth of E.faecalis in blood cultures raised the suspicion of endocarditis, and transesophageal echocardiography revealed vegetations on the aortic and the mitral valves with a perforation of the anterior mitral leaflet. Since the patient responded well to antibiotic treatment and there was no progression of the size of the vegetations or the perforation, it was decided by the endocarditis team to refrain from surgery.

E. faecalis endocarditis can be difficult to diagnose because the patients are often elderly, and symptoms may be subtle and misleading. In the present case, the diagnostic process was based on the Danish IE guidelines, which state that E. faecalis is a typical IE bacterium. Accepting E. faecalis as a typical infective endocarditis bacterium may lead to an earlier diagnosis and treatment.