Lactococcus garvieaeendocarditis presenting with subdural haematoma

Abstract

BackgroundLactococcus garvieae is a rare cause of infective endocarditis (IE) in humans and the bacterium can easily be misidentified. Intracranial haemorrhage often occurs in conjunction with IE, but subdural haemorrhage (SDH) is very rarely encountered.Case presentationThe patient was an 81-year-old male with a history of cardiovascular disease and a prosthetic biologic aortic valve. He presented with fatigue and an acute onset of headache. Computed tomography (CT) revealed a left-sided fronto-temporal subdural haematoma. Low-grade fever was noted and blood cultures yielded growth of L. garvieae. Transesophageal echocardiography (TEE) revealed small vegetations on the native mitral valve and on the prosthetic aortic valve. Treatment with penicillin and tobramycin was initiated and the recovery was slow but uneventful.ConclusionThis is the first report of a case where SDH was the sole presenting neurological sign of IE. The case demonstrates that IE should be considered in patients with SDH where a history of trauma is absent, especially if the patient has fever or predisposing conditions such as a prosthetic heart valve.

Endocarditis por Lactococcus garvieae en un paciente sometido a hemodialisis crónica. Primer caso reportado en Chile y revisión de la literatura

“…Según el tipo de infección, hubo 20 endocarditis infecciosas, (11 de válvulas mitrales nativas [4][5][6][7][8][9][10][11][12] , tres de prótesis de válvula mitral 7,13,14 , tres válvulas aórticas nativas 2,12,15 , dos prótesis de válvula aórtica 9,16 y una válvula tricúspidea 17 ), dos casos de bacteriemia 4,18 , dos casos de septicemia 4,19 y dos casos de peritonitis 4,20 . Otros fueron casos aislados de absceso hepático 21 , osteomielitis 22 , colecistitis aguda 23 , espondilitis 24 , infección de prótesis de cadera 25 y un hematoma subdural 9 . La mayoría de los casos se encuentran entre los 40 y 85 años de edad con un solo caso pediátrico, de un paciente de 10 años.…”

Familial Adenomatous Polyposis Manifesting asLactococcusEndocarditis: A Case Report and Review of the Association ofLactococcuswith Underlying Gastrointestinal Disease

“…Given the development of a pseudoaneurysm in the setting of the patient's bacteremia, it is important to consider mycotic aneurysm as the primary nidus of infection, as Lactococcus IE has been reported to occur in the association with mycotic aneurysms [5]. However, the operative findings and pathological analysis of the pseudoaneurysmal tissue did not show any signs of infection consistent with mycotic aneurysm, although surgery was performed following the completion of antibiotic therapy.…”

“…In particular, L. garvieae has been more broadly associated with fish and dairy consumption, with transmission also reported via contaminated water; conversely, L. lactis is associated primarily with dairy products [8, 9]. Importantly, in many of the reported cases, these patients had underlying gastrointestinal (GI) disease, suggesting a portal of entry [1, 5, 7, 10–13]. While not normally part of the GI microbiome, Lactococcus has been isolated from the intestines of humans [1, 10].…”

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis

“…The ensuing blood extravasation pours out either into the brain tissue or the subarachnoid space [27]. In contrast to intraparenchymal, subarachnoid and intraventricular hemorrhage, the occurrence of an acute subdural hematoma (SDH) is extremely rare in the context of IE [28,29,30,31,32,33,34].…”