Right-Sided Tricuspid Infective Endocarditis Caused by Streptococcus Pneumoniae in a Patient with a Long-Standing Implantable Venous Port: A Rare Case Report

Abstract

Background: Right-sided infective endocarditis (IE) is uncommon, accounting for only 5–10% of cases, and is typically associated with intravenous drug use or intracardiac devices. Streptococcus pneumoniae has become a rare cause of IE, especially on the tricuspid valve. Early diagnosis remains challenging due to nonspecific clinical features and frequent respiratory presentations. Case Presentation: We report a 47-year-old male with a history of chronic lymphocytic leukemia in remission, who presented with prolonged fever and dyspnea while carrying an unused implantable venous chamber. Transthoracic echocardiography revealed a large mobile vegetation on the tricuspid valve with severe regurgitation, and blood cultures isolated Streptococcus pneumoniae. Targeted intravenous antibiotic therapy (ceftriaxone and gentamicin), combined with removal of the intravascular device, resulted in rapid clinical improvement and complete recovery. Conclusion: This case highlights a rare presentation of pneumococcal right-sided IE in the absence of classic risk factors. It underscores the importance of considering right-sided IE in persistent fever and supports early device removal and targeted antimicrobial therapy to optimize outcomes.