We report a case of Escherichia coli mitral valve endocarditis of a female in her 70s with native valves who was admitted for the 3 rd time with septic shock while repeated blood cultures were positive for pansensitive Escherichia coli (E coli). She had no risk factors such as immunosuppression, prosthetic valves or congenital heart disease to predispose her to endocarditis. Vegetations were identified on the mitral valve with a transthoracic echocardiogram and the patient underwent a mitral valve replacement with a tissue valve. Histology and culture of the vegetation were negative. The source of recurrent bacteraemia is therefore presumed to be E.coli endocarditis given clinical improvement of the patient up to 6 weeks post valve replacement and possible fulfilment of Duke Criteria. More studies have to be performed to identify specific strains causing endocardial pathology, however past studies have suggested that extraintestinal pathogenic E.coli (‘ExPEC’) might suggest a specific cause.