Four cases are described of Aerococcus viridans endocarditis with favorable outcome, focusing on the clinical picture. Extracardiac findings (e.g. neurological, renal, musculoskeletal, intra-abdominal) in infective endocarditis (IE) have been recognized more frequently in recent years, and may delay the diagnosis and have a negative influence on the prognosis. Aerococcus viridans, a very rare microorganism causing invasive infections, has been associated with bacteremia, septic arthritis, and especially IE. As expected, the strains isolated were susceptible to penicillins, trimethoprim/sulfamethoxazole, and glycopeptides. Medical therapy was sufficient to cure IE in two patients, while two others required surgical intervention.