Bicuspid aortic valve infective endocarditis and aortic root abscess presenting initially as splenic infarctions

Infective endocarditis (1E) commonly complicates bicuspid aortic valve. We report an uncommon case of bicuspid aortic valve (BAV) IE with aortic root abscess (ARA), presenting initially with abdominal pain due to splenic infarcts, delaying prompt diagnosis. A 38-year-old gentleman presented with fever and abdominal pain. He was treated for intra-abdominal sepsis, was started on intravenous antibiotics and had a computed tomography scan of the abdomen that revealed a large splenic infarct. The patient deteriorated, prompting further investigations, including echocardiography due to findings of a new murmur, signs of embolisation and blood cultures revealing Staphylococcus aureus. This revealed an otherwise unknown BAV with aortic valve vegetation and ARA. IE and ARA commonly affect patients with bicuspid aortic valve, and our case highlights the importance of systemic review, as IE often manifest clinically in various forms.

Automated summary

This case report highlights an uncommon case of infective endocarditis with bicuspid aortic valve presenting initially with abdominal pain, leading to splenic infarcts and delaying prompt diagnosis. It emphasizes the importance of thorough review in diagnosing infective endocarditis as it can manifest in various clinical forms.