Septic thromboembolism of the femoral artery from mitral valve endocarditis

Abstract

Acute limb ischemia (ALI) demands prompt diagnosis and intervention to prevent irreversible tissue damage. Although ALI is more common in older patients, especially due to atrial fibrillation, younger patients with ALI require a broader differential to determine the specific cause. This case report describes a 19-year-old male presenting with ALI from septic thromboembolism due to methicillin-sensitive Staphylococcus epidermidis infective endocarditis, and it highlights a few unique management considerations. Specifically, an atypical presentation of ALI should place an infectious etiology higher on the differential, as the presence of infection impacts conduit choice in the event of creating an arterial bypass. Additionally, the vessels involved in the septic thromboembolism can become extremely friable and inflamed, as in this case, to the point that they may not be amenable to an endovascular approach and, even with an open mechanical thrombectomy, still necessitate bypass. Finally, optimal management of this complex case relied on the coordinated efforts of multiple medical specialties, highlighting the importance of a multidisciplinary team approach.