Pneumococcal endocarditis involving the pulmonic valve in a patient with HIV.

Infective endocarditis in drug users commonly targets the tricuspid valves, whereas pulmonic valve endocarditis is a rare occurrence. Staphylococcus aureus rather than Streptococcus species is the culprit organism. Streptococcal pneumonia is also not commonly seen as an etiological agent for endocarditis. Here we present a case of a 57-year-old man with a history of HIV infection on antiretroviral therapy who was admitted for sepsis and found to have pneumococcal bacteremia with vegetation on a pulmonic valve. He had been vaccinated with both pneumococcal conjugate vaccine 13 and pneumococcal polysaccharide vaccine 23 at the time of his HIV diagnosis. Pulmonic valve endocarditis is unusual in the setting of pneumococcal bacteremia in HIV patients previously vaccinated for pneumococcal disease.