Abstract Background Infective endocarditis during pregnancy is rare but associated with significant maternal and fetal morbidity, particularly in the setting of Enterococcus faecalis bacteremia from genitourinary sources. Case Summary A 28-year-old woman at 32 weeks’ gestation with bilateral nephrolithiasis and indwelling nephrostomy tubes presented with sepsis. Blood cultures grew Enterococcus faecalis. Transesophageal echocardiography revealed a mobile aortic valve vegetation with progressive severe aortic regurgitation. A multidisciplinary team coordinated staged management including antimicrobial therapy, genitourinary source control, planned delivery, and postpartum mechanical aortic valve replacement. Discussion This case highlights the strong association between E. faecalis bacteremia and infective endocarditis, the importance of early echocardiography, and the need for individualized, multidisciplinary decision-making in pregnancy.
Zhang et al. (Wed,) studied this question.