Lactobacillus acidophilus Endocarditis Complicated by Pauci-Immune Necrotizing Glomerulonephritis

Abstract

Infective endocarditis (IE) is more common in patients with predisposing cardiac lesions and has many potential complications, including stroke and arterial thromboembolisms. Renal manifestations have an estimated prevalence of ∼20%. Rapidly progressive glomerulonephritis (RPGN) is a nephrological emergency manifested by autoimmune-mediated progressive loss of renal function over a relatively short period of time. Here, we report the case of a 60-year-old Caucasian male, who presented with speech impairment and was found to have multiple embolic strokes caused by aortic valve IE. His renal function declined rapidly, and his urine sediment featured hematuria and proteinuria. ANCA titer was negative by immunofluorescence (IF); however, the PR3 antibody was elevated. The renal biopsy revealed pauci-immune focally necrotizing glomerulonephritis with the presence of ∼25% cellular crescents. He was initially treated with plasmapheresis and pulse dose steroids. Hemodialysis was initiated for uremic symptoms. After four weeks of antibiotic therapy and with blood cultures remaining negative, he was treated with rituximab. Two months after discharge, his renal function showed improvement, and hemodialysis was discontinued. This case highlights several complications associated with lactobacillus endocarditis including RPGN.

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…The retrospective studies of Arbarillo et al, Nwanyanwu et al and Yelin et al [60,61,62] suggested that the true prevalence of infections caused by lactobacilli is higher than estimated only on the basis of case reports. In addition, in many of the reports analyzed here it was stated that lactobacilli are often disregarded as infective agents since they are considered culture contaminants [29,40,61].…”

“…Lactobacilli were isolated from blood [15,16,17,18,20,21,22,23,24,25,26,27,29,30,31,32,33,34,35,36,37,38,40,41,42,43,44,45,46,47,49,52,55,56,57], diseased valve tissue [28], abscess fluids [48,51,52,54,57,58], cerebrospinal fluid (CSF) [46], marrow [36], arthrocentesis aspiration fluid [53] in anaerobiosis and, in some cases, also in aerobiosis [40,15]. Use of automated microbial detection system, i.e.…”

“…• multiple embolic strokes with acute-to-subacute infarct in the brain parietal lobe and a rapidly progressive glomerulonephritis (RPGN) [29]; • splenic abscess [25];…”

“…Chukwurah et al [29] hypothesized that chronic use of ibuprofen could result in erosion of the lining of the GI tract, increasing the likelihood of the entry of lactobacilli originating from dental caries into the blood stream. Bacterial translocation from gut was deemed as possible also in other case reports [22,34,57].…”

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…Lactobacilli were isolated from blood [ 15 , 16 , 17 , 18 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 52 , 55 , 56 , 57 ], diseased valve tissue [ 23 ], abscess fluids [ 48 , 51 , 52 , 54 , 57 , 58 ], cerebrospinal fluid (CSF) [ 46 ], marrow [ 30 ], arthrocentesis aspiration fluid [ 53 ] in anaerobiosis and, in some cases, also in aerobiosis [ 15 , 34 ]. Use of automated microbial detection system, i.e., BACT/ALERT 3D or the BACTEC systems (BioMérieux) with incubation at 35 °C were mentioned in some reports [ 23 , 31 , 34 ].…”