# From Gut to Heart: A Case Report of Infectious Endocarditis Stemming From Cholecystitis-Induced Enterococcus faecium Bacteremia

## TL;DR

This case report shows how a rare infection in the heart was traced back to a hidden infection in the gallbladder.

## Contribution

Highlights the importance of identifying natural bacterial reservoirs in diagnosing recurrent infections.

## Key findings

- Recurrent infective endocarditis was linked to a gallbladder infection with Enterococcus faecium.
- Blood and tissue cultures were key in identifying the bacterial source.
- A multidisciplinary approach was essential in solving the diagnostic mystery.

## Abstract

Systemic infections are not always going to present as we expect. The study of bacteremia and febrile syndrome represents one of the most important diagnostic challenges nowadays. This case demonstrates the importance of a multidisciplinary approach and finding a common point that explains all the patient's symptoms, no matter how disconnected they may seem. Here, we present the case of a patient where multiple treatments were performed to manage recurrent infective endocarditis due to Enterococcus faecium but the cause of this persistence was never found despite surgical management. With only a few cases reported in literature involving this pathogen, it is of great importance to emphasize how searching for a natural reservoir, such as the gallbladder, for this pathogen helped solve the diagnostic mystery that this patient represented. Here, we present how the culture of biological materials, such as the aortic valve replacement, as well as blood cultures, made it possible to identify the etiological agent associated with the pathology and, in turn, find the cause of recurrent bacteremia.