<i>Staphylococcus lugdunensis</i> Pulmonary Valve Endocarditis in a Patient on Chronic Hemodialysis

Abstract

We describe a case of Staphylococcus lugdunensis pulmonary valve endocarditis in a 65-year-old woman on chronic hemodialysis and provide a review of previously reported cases. The patient presented with fever and altered mental status, but had no other localizing symptoms or signs; coagulase-negative staphylococcus (subsequently identified as S. lugdunensis) was isolated from two sets of blood cultures. Transthoracic and transesophageal echocardiograms showed a large (2.3 × 3.1 cm) vegetation on the pulmonary valve with moderate valvular insufficiency. The patient was treated with 6 weeks of antibiotic therapy and is stable 4 months following the completion of therapy; no surgical intervention was performed. Of the 28 previously reported cases of S. lugdunensis endocarditis, only 1 had previously survived with medical therapy alone. This is the 3rd case report of S. lugdunensis endocarditis in a patient on hemodialysis; the presumed portal of entry in this and previously reported cases was the vascular access device. Endocarditis due to this organism is characterized by a high mortality, rapid tissue destruction, and a predilection for native valves. Because the clinical outcome is much more favorable with valvular replacement, speciation of the organism assumes great importance in defining the therapeutic approach.

Isolated Pulmonic Valve Infective Endocarditis: A Persistent Challenge

“…The main predisposing factors for pulmonic valve endocarditis in adults are intravenous drug abuse in 30% of cases, central venous catheters (including Swan-Ganz™ catheters) in 14%, and alcoholism in 11% [4,5]. Isolated pulmonic valve endocarditis has also been identified in patients undergoing chronic HD, orthotopic liver transplantation, and celiac disease [6][7][8][9]. Many cases of pulmonic valve endocarditis are unsuspected and become evident only after confirmatory echocardiogram or at autopsy.…”

From Clinical Microbiology to Infection Pathogenesis: How Daring To Be Different Works forStaphylococcus lugdunensis

“…Three patients on chronic hemodialysis have developed S. lugdunensis endocarditis (89,160,166). In each case, the arteriovenous fistula or venous catheter was suspected to be the origin of infection.…”

Staphylococcus lugdunensis Infections: High Frequency of Inguinal Area Carriage

“…S. lugdunensis peritonitis has been reported in a patient undergoing continuous ambulatory peritoneal dialysis (14) and following delivery by cesarean section (8). Several cases of S. lugdunensis endocarditis have also been reported: in a patient on hemodialysis (14), in a patient after renal transplantation (24), in patients after femoral arterial catheterization, after vasectomy (24), and in association with a scrotal wound (24). Recently, a case of ventriculoperitoneal shunt infection caused by S. lugdunensis was described (5,27).…”

“…These results are consistent with the suggestion that the preferred site of S. lugdunensis carriage may be the perineum rather than the entire skin surface. Associations have been reported between S. lugdunensis endocarditis and inguinal skin breaks occurring in the context of vasectomy (7), scrotal wounds (24), renal transplantation (24), continuous ambulatory peritoneal dialysis (14), femoral arterial catheterization, total-knee arthroplasty (24), prostatic cancer (8), and inguinal furuncle (17,25). Several cases of ventriculoperitoneal shunt infection caused by S. lugdunensis have also been reported (5,27).…”