Pulmonary, Central Nervous System, and Systemic Paradoxical Cardioembolic Events Secondary to Staphylococcus aureus Tricuspid Valve Infective Endocarditis Without Intracardiac Shunt

Infective endocarditis (IE) is an uncommon but potentially fatal cause of systemic infection that may lead to embolic complications in various organs. While left-sided IE commonly causes systemic emboli, right-sided IE typically results in septic pulmonary emboli due to embolization of infected material into the pulmonary circulation. This report describes an unusual case of right-sided tricuspid valve IE caused by <i>Staphylococcus aureus</i>, which resulted in simultaneous pulmonary, cerebral, and peripheral embolic events despite the absence of an identifiable intracardiac or intrapulmonary shunt. A previously healthy middle-aged man presented with fever, confusion, and hemodynamic instability and was found to have extensive septic emboli affecting the lungs, brain, and lower extremities. Diagnostic imaging confirmed large vegetations on the tricuspid valve, while echocardiography ruled out a patent foramen ovale or left-sided involvement. The patient was treated medically with targeted intravenous antibiotics, renal replacement therapy, and vasopressor support, leading to clinical improvement. However, he developed irreversible peripheral ischemia requiring partial amputation and residual renal impairment. This case underscores that right-sided IE can, in rare circumstances, produce paradoxical systemic emboli through mechanisms that remain poorly understood. Awareness of this possibility and early multidisciplinary management are crucial to reducing complications and improving survival.