Challenging Management of Post-transcatheter Aortic Valve Implantation (TAVI) Infective Endocarditis With Neurological and Spinal Complications in an Elderly Patient: A Case Report.

Infective endocarditis (IE) following transcatheter aortic valve implantation (TAVI) is a rare but life-threatening complication, particularly in elderly patients with multiple comorbidities. We describe a case of an 84-year-old woman who developed IE three years after TAVI. The patient initially presented with cerebral embolism and was found to have Streptococcus sanguinis bacteremia. Although initial clinical and imaging findings met only minor Duke criteria, transesophageal echocardiography (TEE) later confirmed a definitive diagnosis by identifying a mobile vegetation measuring 11.2 mm on the prosthetic valve. During hospitalization, the patient developed pyogenic spondylitis, likely secondary to hematogenous spread. Conservative management with antibiotics was initiated; however, persistent back pain and impaired mobility necessitated posterior fixation using percutaneous pedicle screw (PPS). Given her advanced age and underlying liver cirrhosis, surgical valve replacement was considered high-risk and thus, not performed. The patient demonstrated significant clinical improvement with a combination of antimicrobial therapy and minimally invasive spinal surgery. She was subsequently discharged on oral antibiotics with regained functional independence. This case highlights the complexities of diagnosis and management of post-TAVI IE with secondary spinal involvement in geriatric populations.