Subaortic-right atrial fistula after endocarditis in hypertrophic cardiomyopathy

Infective endocarditis in hypertrophic obstructive cardiomyopathy is rare. Management of this disease is challenging due to the unique features of dynamic pressure gradient over the left ventricular outflow tract and its unpredictable interaction with the management of sepsis. The added complexity of infective endocarditis further complicates an already difficult situation. A 72-year-old man with hypertrophic obstructive cardiomyopathy presented with acute stroke, fever, and Staphylococcus aureus bacteremia. Infective endocarditis of the aortic valve was confirmed. Despite treatment with antibiotics and aortic valve replacement, the patient had recurrent bacteremia and developed a periannular abscess and a subaortic-right atrial fistula, with a resulting fatal outcome.