# Infective Endocarditis Caused by Abiotrophia defectiva: A Unique Case Complicated by Mitral Valve Perforation

## TL;DR

A rare case of infective endocarditis caused by Abiotrophia defectiva led to mitral valve perforation and required urgent surgery and long-term antibiotics.

## Contribution

This case highlights the rare but severe complications of Abiotrophia defectiva infective endocarditis and the need for multidisciplinary management.

## Key findings

- Abiotrophia defectiva caused mitral valve perforation and severe regurgitation in a 33-year-old male.
- The patient required urgent mitral valve replacement and 6 weeks of antibiotics.
- Multidisciplinary collaboration is essential in managing complex cases of infective endocarditis.

## Abstract

Abiotrophia defectiva
, a nutritionally variant streptococcus, represents a rare yet serious cause of infective endocarditis (IE), accounting for 1%–2% of the total IE cases. It affects native valves in 10% of patients, and it is implicated in catastrophic complications. A 33‐year‐old medically free male presented with a persistent nonproductive cough for 4 months. It was associated with unintentional weight loss (10 kg); however, he denied any other symptoms. His symptoms started after he had a dental implant. Physical examination was unremarkable except for a systolic murmur. Upon further investigations, a blood culture showed
Abiotrophia defectiva
, and echocardiography demonstrated severe mitral regurgitation originating from the perforation site located on the posterior leaflet measuring 10 × 4 mm, in addition to 2 masses suggestive of vegetations, the largest measuring 10 × 6 mm. The patient was hospitalized as a case of IE and acute mitral valve regurgitation. In light of mitral valve perforation, large vegetation, and bacteremia, an urgent multidisciplinary decision to proceed with mitral valve replacement was made, and the patient received a total of 6 weeks of antibiotics. Physicians should remain highly vigilant for IE, its rare causes, and associated complications. In addition, managing complex cases of IE necessitates a multidisciplinary team approach between cardiology, infectious diseases, and cardiac surgery teams.