Challenges in diagnosing infective endocarditis in the context of recent COVID-19 infection: A case report

Infective endocarditis (IE) is a rare but potentially life-threatening condition with a wide spectrum of clinical presentations, often leading to diagnostic delay. The COVID-19 pandemic has added further complexity by overlapping clinical features and imposing constraints on diagnostic pathways. We report the case of a 48-year-old male who presented with prolonged non-specific symptoms following a recent COVID-19 infection. Multiple emergency department visits resulted in an initial diagnosis of viral illness. Subsequent clinical deterioration prompted further evaluation, which revealed severe aortic regurgitation due to a large aortic valve vegetation on transthoracic echocardiography. Blood cultures grew α-haemolytic Streptococcus mitis fulfilling the modified Duke criteria for IE. The patient developed complications, including heart failure and peripheral arterial embolisation, necessitating urgent surgical aortic valve replacement. This case highlights the diagnostic challenges of IE in the context of recent COVID-19 infection, where overlapping symptoms and altered healthcare pathways may contribute to delayed recognition. Clinicians should maintain a high index of suspicion for IE in patients presenting with persistent or atypical symptoms following COVID-19 infection. Early recognition and prompt intervention are essential to prevent serious complications.