Pregnancy-associated Enterococcus faecalis aortic valve endocarditis secondary to obstructive uropathy: a case report

Infective endocarditis during pregnancy is rare but associated with significant maternal and foetal morbidity, particularly in the setting of Enterococcus faecalis bacteraemia from genitourinary sources.

A 28-year-old woman at 32 weeks’ gestation with bilateral nephrolithiasis and indwelling nephrostomy tubes presented with sepsis. Blood cultures grew E. faecalis. Transoesophageal echocardiography revealed a mobile aortic valve vegetation with progressive severe aortic regurgitation. A multidisciplinary team coordinated staged management, including antimicrobial therapy, genitourinary source control, planned delivery, and postpartum mechanical aortic valve replacement.

This case highlights the strong association between E. faecalis bacteraemia and infective endocarditis, the importance of early echocardiography, and the need for individualized, multidisciplinary decision-making in pregnancy.