• Tsung-Yu Chan, Chih-Chia Hsieh, Chien-Liang Chen, Yao-Yi Huang, and Chia-Chang Chuang.
• Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
• Medicine (Baltimore). 2019 Jun 1; 98 (24): e15961.

IntroductionRight-sided native endocarditis is a difficult case with fewer cardiac symptoms and fewer classic signs of cutaneous vascular lesions compared with left-sided endocarditis.Patient ConcernsA 68-year-old Taiwanese man with a history of gouty arthritis, hyperlipidemia, and adrenal insufficiency presented to our ED and complained dyspnea and low back pain for 1 month.Diagnosis AssessmentThe PE showed bilateral crackles on chest auscultation and a palpable fluctuant mass over the anterior chest wall. The chest and abdominal CT scan showed multiple abscess formations involving pulmonary, sternal, and paraspinal areas. The TEE being performed and an oscillating mass over the anterior and septal leaflets of the tricuspid valve and moderate tricuspid regurgitation.InterventionsOnly pharmacologic treatment without surgical interventions.OutcomesDeceased, patient expired on day 4 after ED visit.ConclusionThis case arose as a sequela of staphylococcal endocarditis associated with persistent bacteremia and immunological dysregulation. The diagnosis of right-sided endocarditis is easily missing, multidisciplinary approach should be triggered as soon as possible, which might lead to a better outcome. Right-sided IE is still an important public health issue in southern Taiwan.

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