Streptococcus mutans endocarditis resulting in severe aortic and mitral valve dysfunction and congestive heart failure - supplementary media

A patient in his 40s with no known cardiac history presented to the emergency department with midsternal chest pain worse on inspiration for the past 1 week. He also complains of recent weight loss, dry cough and night sweats during this time. He describes significant dental pain as well. Electrocardiogram showed no acute ischemic changes. Transesophageal echocardiography showed a nodular echodensity affecting the mitral valve with severe regurgitation, and echodensity affecting the aortic valve with severe regurgitation. Blood cultures grew Streptococcus mutans in multiple samples. He was treated with intravenous antibiotics and had a mechanical aortic and mitral valve replacement. He continued to have persistent left and right ventricular dysfunction several months later despite medical and surgical treatment.