A 54-year-old male, with a history of intravenous drug use, presented with fever, chills, and left-sided weakness, ultimately diagnosed with infective endocarditis caused by Stenotrophomonas maltophilia. Initial echocardiography revealed mitral valve vegetation, followed by two embolic strokes affecting the right middle cerebral artery territory. Blood cultures confirmed S. maltophilia, a multidrug-resistant organism. Treatment involved a combination of trimethoprim-sulfamethoxazole and ceftazidime. Despite antibiotic therapy, the patient developed recurrent embolic events, highlighting the aggressive nature of this infection. Surgical intervention was considered but deemed high risk.
Key note: Stenotrophomonas maltophilia infective endocarditis is rare, aggressive, and often complicated by embolic events, necessitating prompt and appropriate antibiotic therapy against its multidrug-resistant profile.