Infective Endocarditis Induced – Decompensation of Chronic Liver Disease Presenting as Hepatic Encephalopathy

Abstract

Infective endocarditis (IE) occurs in people of older age, with artificial or damaged heart valves, immunocompromised states, and intravenous (IV) drug abusers as major risk factors. This case report describes a rare presentation of IE in a patient with chronic liver disease (CLD). A 38-year-old female with a history of decompensated CLD due to hepatitis C, presented with high-grade fever with chills, abdominal pain, shortness of breath, melena, and altered mental status. On examination, she had signs of hepatic encephalopathy and a systolic murmur in the aortic area. Imaging studies revealed an aortic valve vegetation with moderate aortic regurgitation, and blood cultures were negative. Treatment with meropenem and teicoplanin was started which resulted in clinical improvement. This case highlights the importance of considering IE in patients with CLD presenting with decompensation and suggests that early diagnosis and treatment are crucial in improving outcomes.