Infective endocarditis is a life threatening, noncontagious infection of endocardium, heart valves and intracardiac prosthetic devices and implants. It has been defined as a clinical condition since the 1950s. The clinical diagnosis of endocarditis needs the increased suspicion due to nonspecific clinical presentations. Embolic complications are common clinical findings of infective endocarditis and have prognostic importance for early surgical decision.

In this case report we presented an infective endocarditis patient with multiple recurrent peripheric emboli; one lower extremity and both upper extremities. The patient was 45 years of age male patient who had undefined fever for lasting a week. He was admitted to emergency service with sudden onset of pain in left lower extremity. He was operated due to acute artery occlusion of left lower extremity. The patient had 3/6 systolic murmur at cardiac apex without any previous heart disease history and the other systemic examinations were normal but only fever nearly 38ºC. There was a vegetative view at the mitral valve posterior leaflet at left atrial side with 1,9 X 2,5 cm in size in the echocardiographic investigation. The two blood culture samples for infective endocarditis were taken. 20 hours later the first embolectomy operation, the patient had complains of pain, coldness and colour changes of both of the upper extremity at the same time. The operations were performed due to acute brachial arterial occlusion to both of the upper extremities under local anesthesia.

The next day urgent mitral valve operation was performed with standart mitral valve surgical procedure. The valve with vegetations was removed and replaced by mechanical bileaflet valve (Medtronic ATS Medical, Inc 24 mm Mitral AP valve).

Approximately three weeks later from the left lower extremity embolectomy operation, pseudoaneurysm was detected at the left femoral region in groin. The operation was planned under local anesthesia with the opening of previous surgical site. It was observed that approximately 5 X 8 cm sized ruptured, mycotic aneurysm in the femoral artery. Then the arterial defect was repaired with ipsilateral saphenous vein patch plasty.

In conclusion, the recurrent multiple peripheric emboli without central nervous system involvement is an important urgent surgical intervention of infective endocarditis as in our case. We recommend the operation as soon as possible to prevent the more serious embolic complications that could affect the prognosis of the disease.