Case Presentation: We report a case of outflow tract ventricular septal defect (VSD) manifesting in adulthood with aortic and pulmonary valve infective endocarditis (IE) from Gemella morbillorum. A 33-year-old male presented with fever, night sweats, fatigue and dyspnea for 4 months. Cardiovascular examination revealed a loud to-and-fro murmur with a palpable thrill and water hammer pulses. Echocardiogram showed aorto-right ventricular “communication” with severe left ventricular dilation, vegetations involving aortic and pulmonary valve, aortic root abscess and prolapse of right coronary cusp of aortic valve resulting in severe aortic insufficiency. There was no history of intravenous drug use. Patient’s wife reported that she has felt a thrill on his chest for many years. Within days of presentation patient developed cardiogenic shock with multiorgan dysfunction and had to be taken to the operating room (OR) urgently. In the OR finding of an outflow tract VSD was confirmed and the patient underwent bioprosthetic aortic and pulmonary valve replacements with patch closure of VSD.

Discussion: Patient had an acute presentation of an underlying congenital heart defect that was previously undiagnosed. Infective endocarditis is not uncommon in hospital medicine practice, however our patient progressed to cardiogenic shock rapidly due to involvement of both the aortic and pulmonary valves and the presence of aorto-right ventricular “communication” from a hitherto unknown VSD. Differential diagnosis of such presentation findings includes ruptured sinus of Valsalva as a complication of aortic valve endocarditis, however typical appearance on echo and patients history helped in diagnosis and management with surgery by an adult congenital heart disease surgeon.

Conclusions: This case highlights a serious complication of IE and additionally underlines the importance of evaluating for all risk factors or conditions that predispose to IE, including congenital heart disease.