ressElmer Aortic Insufficiency Secondary to Enterococcus faecalis Endocarditis in an HIV-Positive Patient

Enterococcus faecalis is the third most common cause of endocardi-tis. HIV infection is an independent risk factor for the development of endocarditis when the cell count is below 200 cells/mL and without retroviral therapy. A 49-year-old Caucasian male, with HIV infection in triple therapy, no detectable viral counts and CD4 cell count over 1,000 cells/mL, is admitted to the hospital with dyspnea and an acute bacterial infection. On the physical exam, he presented tachycardia, systolic murmur I/IV, bilateral basilar rales, hypotension and fever. The echocardiogram showed an aortic valve vegetation, with pro-lapse of one of the leaflets, severe aortic insufficiency, mild mitral regurgitation and severe pulmonary hypertension. CXR with bilateral infiltrations and CT scan showed in addition mediastinal lymphad-enopathy. He underwent an emergency cardiac surgery replacing his aortic valve for a prosthetic, and the culture of the vegetation was positive for E. faecalis. Treatment with vancomicin and gentamicin was initiated. Infective endocarditis by E. faecalis in this patient had probably a non-HIV-related etiology because of the adequate antiret-roviral therapy that he was having. Most probably the rectal abscess could have been the source of the sepsis