- Streptococcus pneumoniae endocarditis is uncommon. It has a predilection for the aortic valve and is associated with high mortality. We present 3 consecutive cases of pneumococcal endocarditis, each preceded by a different extracardiac infection but all causing destructive aortic valve lesions associated with severe regurgitation, in the absence of vegetations on transesophageal echocardiography. This case series illustrates the aggressive nature of pneumococcal endocarditis and the need for early diagnosis. Echocardiography should be considered in all individuals with persistent extracardiac pneumococcal infections.