Enterococcus faecalis is an enteric microorganism that, if introduced into the vasculature, is an uncommon cause of infective endocarditis. Timely diagnosis, appropriate treatment measures, and close follow-up are key to therapeutic success. Antibiotic therapy is the mainstay of therapy, and surgical intervention is sometimes indicated. Here we present a novel case of a 45-year-old transgender male with Factor V Leiden deficiency who was found to have Enterococcus faecalis mitral valve endocarditis due to the postoperative complications of colovesical fistula formation leading to extended-spectrum beta-lactamase (ESBL) urinary tract infection (UTI) and E. faecalis bacteremia in the setting of recent phalloplasty, mastectomy, and vaginal eversion.

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