Severe tricuspid valve destruction due to untreated endocarditis

A 23 years old previously healthy man, admitted for tricuspid infective endocarditis complicated with severe tricuspid regurgitation and multiple septic pulmonary embolism. (A and B). Blood cultures grew multiresistant Enterobacter cloacae. He was treated with imipenem 3g per day with amikacin 900 mg per day for 22 days. Given the uncontrolled infection and the worsening of the tricuspid regurgitation, surgery was indicated but was not performed due to a lack of means.