Coronary septic embolism presenting as acute myocardial infarction: A rare manifestation of infective endocarditis: a case report.

Background: Acute ST-elevation myocardial infarction (STEMI) secondary to septic coronary embolization is an exceptionally uncommon complication of Infective endocarditis (IE). It's diagnostic and therapeutic complexity poses a unique challenge in clinical management. Case summary: A 79-year-old woman with a history of asthma, dyslipidemia, and breast cancer status post right mastectomy presented to the emergency department with acute STEMI secondary to septic coronary embolization caused by IE of both mitral and aortic valves in addition to the presence of perivalvular abscess. Coronary angiography revealed distal occlusion of the left anterior descending (LAD) artery, and because of the embolic and infectious nature of occlusion, balloon angioplasty without stent placement was performed. Our patient needed urgent surgical intervention; however, surgery was not feasible, leaving prolonged antibiotic treatment as the only possible option. Although treatment with antibiotics alone initially achieved clinical stabilization, the abscess persisted on follow-up imaging, and 2 months later, the patient developed cardiogenic shock and passed away. Conclusion: This case emphasizes the importance of having a high index of suspicion in the diagnosis of STEMI secondary to IE. It also highlights diagnostic and therapeutic challenges, in which early recognition relies on careful clinical assessment and appropriate imaging. Our case draws attention both to the limitations of antibiotic therapy when used alone and stresses the importance of continuous monitoring in patients who are not surgical candidates, although early escalation of treatment, including surgical intervention when indicated, is essential to improve outcomes.