Eustachian Valve Endocarditis: A Case Report and Literature Review.

Infective endocarditis (IE) is a well-known condition, but certain manifestations, such as Eustachian valve endocarditis (EVE), remain rare. This report presents a case of EVE in a 66-year-old male with no apparent risk factors. EVE is a form of right-sided endocarditis, often associated with intravenous drug use, yet it can occur in patients without traditional risk factors. The patient presented with a constellation of symptoms, including lightheadedness, dyspnea, generalized weakness, and fever. Diagnostic workup revealed multiple complications, including liver abscesses, pulmonary nodules, and spinal osteomyelitis. EVE was confirmed through transesophageal echocardiography (TEE), highlighting multiple Eustachian valve vegetations. Blood cultures identified Bacteroides fragilis as the causative agent. The patient received appropriate antimicrobial therapy, underwent drainage of liver abscesses, and was started on therapeutic anticoagulation for thrombophlebitis. A favorable clinical response was observed, and the patient was discharged for continued outpatient follow-up. This case underscores the importance of considering atypical forms of endocarditis, such as EVE, even in patients lacking traditional risk factors. The diagnostic utility of TEE and the management of complications, including liver abscesses and thrombophlebitis, are discussed. Awareness of such presentations is essential for timely diagnosis and effective treatment.