Silent Valves, Painful Abdomen: Missed Infective Endocarditis Revealed by Splenic Abscess

Abstract

Exclusion of infective endocarditis (IE) based solely on the absence of an audible murmur or traditional predisposing risk factors is a critical diagnostic error, as a significant proportion of patients lack these features at presentation. A splenic abscess, while a clear indicator of underlying sepsis, often originates from an unrecognized cardiac source. This case exemplifies such a presentation: a 38-year-old male presented to the emergency department with persistent left lower quadrant abdominal pain and low-grade fever—symptoms that effectively masked the presence of IE. Despite the absence of cardiac complaints or classical peripheral stigmata, the patient was found to have splenic involvement due to septic embolization from unrecognized endocarditis. Although he was ultimately treated successfully with a four-week course of intravenous antibiotics, the delay in diagnosis rendered percutaneous drainage unsuccessful, necessitating an otherwise avoidable splenectomy. This surgical intervention, while curative in the short term, confers a lifelong vulnerability to overwhelming post-splenectomy infection, highlighting the imperative for early recognition of atypical IE presentations.