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Unexpected death secondary to streptococcus salivarius endocarditis

A 51-year old male with a medical history of chronic ethanol and tobacco use was complaining of difficulty breathing and was driven to the local emergency department where he was noted to be in respiratory distress.  The decedent had not seen a physician in over ten years.  The decedent was undergoing an ultrasound to evaluate for a lower extremity deep venous thrombosis when he arrested.  He was unable to be resuscitated.  An autopsy was performed.  The external examination revealed numerous petechial type hemorrhages of the skin with prominence of the arms and lower legs.  Internal examination revealed cardiomegaly (heart weight 720 grams) with left ventricular hypertrophy and prominent endocarditis of the mitral and aortic valves.   Infarcts were noted involving the right kidney and the spleen.  A postmortem blood culture grew Streptococcus salivarius in both the aerobic and anaerobic culture bottles.  