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Infective endocarditis (IE) is a well-known condition, but certain manifestations, such as Eustachian valve endocarditis (EVE), remain rare. This report presents a case of EVE in a 66-year-old male with no apparent risk factors. EVE is a form of right-sided endocarditis, often associated with intravenous drug use, yet it can occur in patients without traditional risk factors. The patient presented with a constellation of symptoms, including lightheadedness, dyspnea, generalized weakness, and fever. Diagnostic workup revealed multiple complications, including liver abscesses, pulmonary nodules, and spinal osteomyelitis. EVE was confirmed through transesophageal echocardiography (TEE), highlighting multiple Eustachian valve vegetations. Blood cultures identified Bacteroides fragilis as the causative agent. The patient received appropriate antimicrobial therapy, underwent drainage of liver abscesses, and was started on therapeutic anticoagulation for thrombophlebitis. A favorable clinical response was observed, and the patient was discharged for continued outpatient follow-up. This case underscores the importance of considering atypical forms of endocarditis, such as EVE, even in patients lacking traditional risk factors. The diagnostic utility of TEE and the management of complications, including liver abscesses and thrombophlebitis, are discussed. Awareness of such presentations is essential for timely diagnosis and effective treatment., Competing Interests: Conflict of interest: There is no conflict of interest., (© 2024 Greater Baltimore Medical Center.)

Abstract: In the intravenous drug user (IVDU) population, infected right‐sided valvular lesions are common, and this has been well described in the literature. The Eustachian valve (also known as the valve of the inferior vena cava) is another valve in close proximity to the tricuspid valve, which can, in rare cases, be the focus of infection. Eustachian valve endocarditis may be an under‐recognised complication of Staphylococcus bacteraemia in IVDU population, often only identified by transesophageal imaging. We present a case of tricuspid valve endocarditis in an IVDU with secondary seeding on the Eustachian valve, and an accompanying literature review on this rare topic. [ABSTRACT FROM AUTHOR]

Endocarditis is a serious infectious disease of the endocardial surface of the heart, predominantly involving the heart valves, and it results from the colonization and proliferation of microorganisms within the bloodstream. The condition primarily affects individuals with underlying cardiac abnormalities or those who have undergone invasive procedures. Symptoms may include pyrexia, fatigue, arthralgia, and new cardiac murmur. We present a case of a young male patient who had recently undergone surgery and developed eustachian valve endocarditis (EVE), a condition scarcely described in the literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Moyer et al.)

The eustachian valve (EV) is a vestigial structure found at the junction of the inferior vena cava and the right atrium, a remnant of the embryological sinus venosus that may persist throughout life. Right-sided infective endocarditis of the eustachian valve remains a distinctly rare and under-diagnosed entity. Commonly known risk factors of eustachian valve endocarditis (EVE) are intravenous drug use, in-dwelling intracardiac devices, and central lines, although more recently immunocompromised states, e.g. uncontrolled diabetes mellitus and old age, have been recognized as risk factors for the disease. Although Staphylococcus aureus has been the most commonly implicated organism, cases of infections with gram-negative organisms are emerging. We present a 47-year-old male with uncontrolled type 1 DM who initially presented to the ED with complaints of low back pain and dysuria and was later found to have eustachian valve endocarditis ultimately treated with intravenous antibiotics., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Fichadiya et al.)

Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, in patients with pacemaker or central venous lines and in patients with congenital heart disease. The vast majority of cases involve the tricuspid valve. Eustachian valve endocarditis is an uncommon disease with similar signs and symptoms of the tricuspid valve endocarditis. A series of only 16 cases of eustachian valve endocarditis are reported in the literature. Case Presentation We present a case of a 25-year old woman with intravenous drug abuse who had a staphylococcus aureus tricuspid valve endocarditis associated to eustachian valve endocarditis. Transthoracic echocardiography, as first line examination, showed the vegetations on tricuspid and eustachian valve. Conclusion Our case describe an unusual location of right side endocarditis in a intravenous drug abuser. In our case, in accord with other cases described in the literature, transthoracic echocardiography disclosed eustachian valve endocarditis. Antimicrobial management is not altered by the recognition of eustachian valve endocarditis. Antibiotic treatment and duration of eustachian endocarditis depends on the isolated organism and is similar to antibiotic therapy used in native valve endocarditis.

Infective endocarditis in patients with intravenous drug use commonly involves right-sided heart valves. Eustachian valve ( EV) endocarditis is not commonly seen given the valve's infrequent presence. Involvement of the coronary sinus ( CS) with endocarditis is also an unusual finding. We present a case with echocardiographic findings consistent with EV endocarditis along with CS involvement, which appropriately responded to antibiotics. [ABSTRACT FROM AUTHOR]