Mitral valve endocarditis with high level aminoglycoside resistant Enterococcus faecalis in breast cancer patient

Introduction: Enterococci represent the third most common cause of infective endocarditis, after streptococcus and Staphylococcus aureus, and are responsible for 5–20% of all cases of endocarditis. We present a rare case of native valve Enterococcus faecalis (E. faecalis) endocarditis of mitral valve in a breast cancer patient. Case Report: A 56­year­old breast cancer patient presented with complains of fever and found to have E. faecalis bacteremia. Echocardiogram showed mitral valve vegetations. This E. faecalis strain was also found to have high level aminoglycoside resistance (HLAR). She responded well to six weeks ampicillin and ceftriaxone combination therapy despite loss of aminoglycoside synergy. Conclusion: Most commonly observed risk factors for enterococcal endocarditis were rheumatic fever, valvular heart abnormalities, gastrointestinal neoplasia, surgery (dental surgery, cardiovascular surgery, and abdominal surgery), gastrointestinal procedures and diabetes. Left­sided enterococcal endocarditis in our patient responded well to combination regimen with ampicillin and ceftriaxone despite loss of aminoglycoside synergism.