Native-valve Staphylococcus epidermidis endocarditis complicated by destructive pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a case report and review of the literature.

BACKGROUND: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) represents a rare but severe complication of infective endocarditis, classically associated with highly virulent organisms such as Staphylococcus aureus. Staphylococcus epidermidis, a coagulase-negative staphylococcus traditionally considered a low-virulence commensal, is increasingly recognized as a cause of clinically significant native-valve endocarditis.

CASE SUMMARY: We report a 72-year-old man with native bicuspid aortic valve who presented with syncope and was found to have S. epidermidis bacteraemia. Transthoracic echocardiography demonstrated an aortic valve mass, but transoesophageal echocardiography (TEE) revealed extensive periannular destruction including MAIVF pseudoaneurysm, posterior aortic annular abscess, and a large mitral valve vegetation with associated thrombus. Neuroimaging confirmed multiple embolic cerebral infarcts. Despite aggressive medical therapy, the patient's clinical trajectory precluded surgical intervention, and he ultimately transitioned to comfort-focused care.

CONCLUSION: To our knowledge, this represents one of the first reported cases of native-valve S. epidermidis endocarditis complicated by destructive MAIVF involvement in the absence of prosthetic material. This case underscores the underappreciated pathogenic potential of coagulase-negative staphylococci and highlights the critical role of TEE in detecting periannular complications that may be missed on transthoracic imaging.