Introduction
Infective endocarditis (IE) and osteomyelitis are rare and potentially
life-threatening infections. Staphylococcus aureus (S.
aureus ) is the most common pathogen associated with both osteomyelitis
and IE, with a proclivity of infections resulting from
methicillin-sensitive strains [1-3]. Concomitant vertebral
osteomyelitis and IE have been documented in the literature, but only in
about 10% of osteomyelitis cases [4]. In IE, aberrations in
valvular structure often contribute to nidus formation. This fosters a
bacteria-rich environment that can seed secondary infections throughout
the body. Spinal dissemination of endocarditis infections most commonly
arise in the lumbar spine, with a minority of cases involving cervical
and thoracic vertebrae [1].
Instances of embryological heart remnants contributing to endocarditis
have been infrequently documented in the literature. Of those cases,
less than 50 involve an embryological remnant of the inferior vena cava,
known as the eustachian valve (EV). Persistent EVs occur in
approximately 4% of the general population and are generally a benign
and incidental finding [5]. In the setting of prolonged bacteremia,
intravenous drug use, and indwelling catheters, EV remnants have the
potential to facilitate bacterial growth, most commonly with S.
aureus [6]. To our knowledge, EV endocarditis has yet to be
reported in the presence of thoracic osteomyelitis. In this case, we
report a 43-year-old African American male presenting with
encephalopathy stemming from treatment-resistant osteomyelitis of the
thoracic vertebrae caused by MRSA. Further investigation revealed an
elusive nidus of infection stemming from an EV remnant.