# Salmonella Endocarditis: Rare Bacteremia Causing Mural Infective Endocarditis

## TL;DR

A rare case of Salmonella endocarditis in a patient with heart devices highlights the need for cardiac imaging in atypical bacteremia.

## Contribution

This case demonstrates that cardiac imaging may be beneficial in patients with cardiac devices and atypical bacteremia.

## Key findings

- Salmonella bacteremia led to right atrial mural endocarditis in a patient with implantable devices.
- Removal of infected devices in the operating room prevented embolization risks.
- Eight-month follow-up showed no recurrence after 6 weeks of antibiotic therapy.

## Abstract

Current guidelines do not recommend routine cardiac imaging in patients with gram-negative bacteremia, as gram-negative infective endocarditis is rare. Nongastrointestinal Salmonella infections causing endocarditis are even more uncommon, especially in the developed world. We present the case of a 60-year-old female with Salmonella bacteremia, ultimately found to have a right atrial mural endocarditis involving an implantable cardioverter–defibrillator and an indwelling venous catheter. The vegetation and indwelling devices were removed from the operating room due to the high concern of embolization if performed percutaneously, and she completed 6 weeks of antibiotic therapy. Both indwelling devices were later replaced once treatment was completed, and there was no evidence of recurrence at the 8-month follow-up. This case proves that in those with cardiac implantable electronic devices and other indwelling devices which enter the heart, who are found to have atypical bacteremia, may benefit from cardiac imaging as a part of their workup.