Are we missing anaerobic infective endocarditis in some acute coronary syndromes?

A 76-year-old man presented with a 3-week history of intermittent fevers and dyspnoea on exertion after a dental bridge placement 2 months ago. The patient's medical history was significant for mild to moderate mitral valve prolapse. Initial evaluation was notable for a 3/6 systolic apical murmur. Laboratory investigations revealed leucocytosis and elevated erythrocyte sedimentation rate, C reactive protein and cardiac biomarkers. Patient was treated initially for non-ST elevation myocardial infarction. A 2-dimensional echocardiography was concerning for a new mitral regurgitation and a questionable vegetation adjacent to the mitral valve annulus. Transoesophageal echocardiography study confirmed the diagnosis. Subsequent microbial identification was notable for Peptostreptococci and he was started on intravenous penicillin therapy. The unexplained illness with underlying valve disease prompted consideration of infective endocarditis. This case describes a rare occurrence of anaerobic endocarditis imitating an acute coronary event.