A SILENT INVADER: CUTIBACTERIUM ACNES ENDOCARDITIS PRESENTING WITH OBSTRUCTIVE MITRAL VEGETATION AND CATASTROPHIC EMBOLIC COMPLICATIONS

Background: Infective endocarditis (IE) is a life-threatening condition, particularly in elderly patients with high mortality rates if not treated promptly. An uncommon but severe manifestation of IE is the development of obstructive vegetation on the native mitral valve, leading to systemic embolization including coronary embolism, splenic and renal infarction with hemorrhagic transformation of cerebral stroke.While cases of prosthetic mitral valve endocarditis with resultant stenosis have been reported such as cases involving Cutibacterium acnesinfection,stenotic complications in native mitral valve endocarditis remain exceptionally rare. The management of such cases is particularly challenging due to the critical balance between the urgent need for surgical intervention and the heightened hemorrhagic risk that may contraindicate anesthesia, thus future guidelines should establish specific criteria to optimize surgical decision-making in these high-risk scenarios. Case presentation:We present a case of infective endocarditis affecting the native mitral valve characterized by an obstructive vegetation caused by Cutibacterium acnes.The condition was complicated by multiple embolic events involving the coronary, cerebral, renal, and splenic circulation. The development of embolic phenomena in infective endocarditis is not uncommon,but their occurrence as a result of a vegetation obstructing the mitral valve is an atypical presentation, requiring immediate intervention. Conclusion: While embolic complications are a well-recognized consequence of infective endocarditis, their occurrence secondary to a mitral valve obstruction remains an unusual presentation, necessitating urgent intervention.