THE SILENT SIEGE: A CASE REPORT ON NATIVE VALVE MRSA ENDOCARDITIS AND THE CASCADE OF EMBOLIC STORMS

Infective endocarditis (IE) is a serious infection impacting the heart's valves and inner lining. Despite advances in diagnostic modalities, antimicrobial therapies, and surgical treatments, IE remains a worldwide health challenge. Key risk factors include congenital heart anomalies and rheumatic heart disease, which is more common in regions like India. Mortality rates for native and prosthetic valve IE are comparable early on, but infections caused by gram-negative bacteria and fungi tend to have worse outcomes. Clinical diagnosis integrates symptoms, microbiology, and imaging methods per the modified Duke criteria. A middle aged woman with no known comorbidities prolonged episode of intermittent fever and progressive fatigue, complicated by exertional dyspnea. Examination revealed pallor, pedal edema, a new murmur, and papilledema. Initial investigations showed anemia, leukocytosis, and systemic inflammation, with negative tropical infection workup. Blood cultures via multiplex PCR grew methicillin-resistant Staphylococcus aureus. Echocardiography confirmed a large vegetation on the aortic valve. CT imaging revealed splenic infarcts, hepatosplenomegaly, pericardial effusion, and thrombus in the superior mesenteric artery. Bone marrow aspiration showed hemophagocytic lymphohistiocytosis, and tropical infections were ruled out. Antimicrobial therapy was tailored to culture sensitivity, with anticoagulation started after embolic complications. This case highlights the aggressive course and systemic embolic complications characteristic of native valve MRSA infective endocarditis. It emphasizes the necessity for prompt diagnosis, comprehensive monitoring, coordinated multidisciplinary care, and timely surgical intervention to optimize patient outcomes.