Tricuspid Valve Endocarditis: A Case of Klebsiella pneumoniae With Pulmonic Embolization.

BACKGROUND

Tricuspid valve endocarditis due to Klebsiella pneumoniae is rare but severe, with metastatic complications.

CASE SUMMARY: A 39-year-old woman with a history of substance use disorder (SUD) and previous infective endocarditis (IE) presented with fever, necrotizing pneumonia, and vision loss. Transesophageal echocardiography revealed tricuspid valve vegetation, and blood cultures confirmed Kpneumoniae, meeting Duke-ISCVID criteria for IE. Imaging showed septic pulmonary emboli and splenomegaly; retinal detachment was noted, but its link to the IE remained unclear. The patient improved with 6 weeks of ceftriaxone therapy, although valve repair was avoided given high relapse risk.

DISCUSSION: Kpneumoniae endocarditis (1.5% of cases) involves aggressive valvular destruction and embolic events. This case highlights diagnostic challenges (negative transthoracic echocardiography), systemic complications, and management dilemmas in patients with SUD. Uncertain retinal detachment linkage emphasizes shunt evaluation in systemic embolization.

TAKE-HOME MESSAGES: Maintain high suspicion for tricuspid endocarditis in SUD patients with septic emboli; transesophageal echocardiography is critical. Multidisciplinary care with prolonged antibiotics and harm-reduction strategies is vital.