A rare case of emphysematous endocarditis caused by Escherichia coli

Infective endocarditis (IE) is an infection of the heart endocardium with significant morbidity and mortality. Gram negative infection particularly emphysematous type of IE is an extremely rare and life-threatening disease. We report a 59-year-old diabetic woman who was admitted to the Rustaq Hospital, Rustaq, Oman in 2017 with the diagnosis of pneumonia for which she was started on antibiotics. Shortly afterwards, she developed facial and mouth deviation and became more tachypneic. Computed tomography of the brain demonstrated bilateral multiple small infarcts. Pulmonary angiography computed tomography (CTPA) was performed which ruled out pulmonary embolism. Nonetheless, it revealed an air containing lesion around the mitral valve. Transthoracic echocardiography demonstrated a hyperechoic mobile lesion related to the mitral valve. Blood culture grew Escherichia Coli (E. coli). Diagnosis of E. coli Emphysematous IE was made based on modified Duke criteria. Recommended treatment for non-HACEK IE includes extended antibiotic course and surgery for selected patients. Keywords: Endocarditis; Escherichia coli; Mitral Valve; Echocardiography; Embolism, Intracranial; Emphysema; Case Reports; Oman.