{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T21:07:41Z","timestamp":1784408861387,"version":"3.55.0"},"reference-count":15,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,17]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>A woman in her 30s, with a background of ulcerative colitis with total colectomy and ileostomy, presented at 36 weeks gestation with headache and transient aphasia. Magnetic resonance imaging of the brain identified multiple cerebral emboli. Given her history of previous ischaemic stroke, she was commenced on dual antiplatelet therapy. She continued to deteriorate, developing fevers and tachycardia. Transthoracic echocardiogram revealed a large vegetation on her aortic valve, and the blood cultured <jats:italic>Enterococcus faecalis (E. faecalis<\/jats:italic>). The bacteraemia source was attributed to subacute bacteraemia secondary to a small bowel resection and parastomal hernia repair for closed loop bowel obstruction at 28 weeks. Following a large multidisciplinary team meeting, the decision was made for emergency caesarean section, followed by same day aortic valve replacement. The patient went on to have a placental abruption and had emergency surgery despite being on clopidogrel. She recovered well and was discharged on a prolonged course of antibiotics and lifelong anticoagulation.<\/jats:p>","DOI":"10.1136\/bcr-2025-266212","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T10:25:20Z","timestamp":1751279120000},"page":"e266212","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["<i>Enterococcus faecalis<\/i> aortic valve infective endocarditis in the third trimester of pregnancy presenting with septic cerebral emboli"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6762-8463","authenticated-orcid":false,"given":"Emily","family":"Everson","sequence":"first","affiliation":[{"name":"Obstetrics & Gynaecology, Townsville Hospital and Health Service, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matisse","family":"Fox","sequence":"additional","affiliation":[{"name":"Obstetrics & Gynaecology, Townsville Hospital and Health Service, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Frost","sequence":"additional","affiliation":[{"name":"Obstetrics & Gynaecology, Townsville Hospital and Health Service, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025082707114825000_18.6.e266212.1","doi-asserted-by":"crossref","unstructured":"Wahbah Makhoul G , Lahoud C , Asogwa N , et al . Infective Endocarditis in Pregnancy: Unveiling the Challenges, Outcomes, and Strategies for Management. SN Compr Clin Med 2024;6. doi:10.1007\/s42399-024-01694-2","DOI":"10.1007\/s42399-024-01694-2"},{"key":"2025082707114825000_18.6.e266212.2","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1055\/a-1877-5763","article-title":"Infective Endocarditis in Pregnancy: A Contemporary Cohort","volume":"41","author":"Countouris","year":"2024","journal-title":"Am J Perinatol"},{"key":"2025082707114825000_18.6.e266212.3","doi-asserted-by":"crossref","first-page":"3713","DOI":"10.1016\/j.radcr.2022.07.006","article-title":"Cerebral venous sinus thrombosis in pregnancy presenting with hemiplegia: A case report","volume":"17","author":"Mahmoud","year":"2022","journal-title":"Radiol Case Rep"},{"key":"2025082707114825000_18.6.e266212.4","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics12040704","article-title":"Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge","volume":"12","author":"Herrera-Hidalgo","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"2025082707114825000_18.6.e266212.5","doi-asserted-by":"crossref","unstructured":"Herrera-Hidalgo L , de Alarc\u00f3n A , L\u00f3pez-Cortes L , et al . n.d. Enterococcus faecalis Endocarditis and Outpatient Treatment: A Systematic Review of Current Alternatives. Antibiotics (Basel) 9:657. doi:10.3390\/antibiotics9100657","DOI":"10.3390\/antibiotics9100657"},{"key":"2025082707114825000_18.6.e266212.6","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0167-5273(88)90171-4","article-title":"Acute bacterial endocarditis on a normal aortic valve following vaginal delivery","volume":"18","author":"Hughes","year":"1988","journal-title":"Int J Cardiol"},{"key":"2025082707114825000_18.6.e266212.7","doi-asserted-by":"crossref","first-page":"920","DOI":"10.5152\/AnatolJCardiol.2021.29797","article-title":"Postpartum infective endocarditis with Enterococcus faecalis after vaginal delivery","volume":"25","author":"Dural","year":"2021","journal-title":"Anatol J Cardiol"},{"key":"2025082707114825000_18.6.e266212.8","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1093\/jac\/dkac258","article-title":"Infective endocarditis in pregnant women without intravenous drug use: a multicentre retrospective case series","volume":"77","author":"Escol\u00e0-Verg\u00e9","year":"2022","journal-title":"J Antimicrob Chemother"},{"key":"2025082707114825000_18.6.e266212.9","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1093\/cid\/ciac777","article-title":"Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse","volume":"76","author":"Danneels","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2025082707114825000_18.6.e266212.10","doi-asserted-by":"crossref","first-page":"105547","DOI":"10.1016\/j.phrs.2021.105547","article-title":"Antiplatelet therapy in pregnancy: A systematic review","volume":"168","author":"Nana","year":"2021","journal-title":"Pharmacol Res"},{"key":"2025082707114825000_18.6.e266212.11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.cjco.2021.08.006","article-title":"Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery","volume":"4","author":"Huo","year":"2022","journal-title":"CJC Open"},{"key":"2025082707114825000_18.6.e266212.12","unstructured":"Hickenbottom S . Cerebrovascular disorders complicating pregnancy, 2024. Available: https:\/\/www.uptodate.com\/contents\/cerebrovascular-disorders-complicating-pregnancy"},{"key":"2025082707114825000_18.6.e266212.13","article-title":"Anticoagulants for acute ischaemic stroke","volume":"10","author":"Wang","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082707114825000_18.6.e266212.14","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/B978-0-12-819814-8.00008-1","article-title":"Neurologic complications of infective endocarditis","volume":"177","author":"Chakraborty","year":"2021","journal-title":"Handb Clin Neurol"},{"key":"2025082707114825000_18.6.e266212.15","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s12471-023-01771-6","article-title":"Distant embolisation in infective endocarditis: characteristics and outcomes","volume":"31","author":"Duffels","year":"2023","journal-title":"Neth Heart J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266212","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:11:53Z","timestamp":1756303913000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":15,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,30]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2025-266212"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266212","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}