Osteomyelitis and possible endocarditis secondary to Lactococcus garvieae: a first case report

Abstract

A 17 year old girl with active Crohn's colitis developed idiopathic thrombocytopenic purpura that was managed with intravenous immune globulins and cyclosporin A. The possible association between Crohn's disease and immune thrombocytopenia is explored. (Postgrad Med J 2000;76:299-300) Keywords: Crohn's disease; colitis; thrombocytopenia Various autoimmune diseases have been associated with inflammatory bowel disease, with the majority of reports describing clustering of autoimmune haemolytic anaemia 1 with ulcerative colitis. An unusual case of Crohn's colitis with the subsequent development of idiopathic thrombocytopenic purpura (ITP) is described. Case reportA 17 year old girl with a history of Crohn's pancolitis without ileal involvement since age 8, was relatively well until the age of 16, when she had several hospitalisations for exacerbations of her Crohn's disease. This necessitated a medical regimen of prednisone (30 mg/day), azathioprine (100 mg/day), metronidazole, and mesalamine but the symptoms of colitis persisted.Apart from an anaemia of chronic disease (packed cell volume 0.247), her blood counts were normal until May 1996 when her platelet count was 3 × 10 9 /l, haemoglobin 85 g/l, packed cell volume 0.258, and leucocyte count 9.2 × 10 9 /l. She was also experiencing epistaxis and bloody diarrhoea. She had no history of recent viral infections, immunisations, recent blood transfusions, or use of recreational drugs. Physical examination revealed only mild cushingoid facies and there was no hepatosplenomegaly. Erythrocyte sedimentation rate was 60 mm/hour. Antinuclear antibodies, anti-HIV, Coombs' tests, platelet associated IgG, white cell diVerential, partial thromboplastin time, and prothrombin time were unremarkable. A peripheral blood smear showed marked thrombocytopenia with occasional giant platelets and no evidence of microangiopathic haemolytic anaemia. A bone marrow biopsy specimen revealed normocellularity with megakaryocytic hyperplasia compatible with peripheral platelet destruction.The patient's medications were discontinued and she was managed initially with methylprednisone (2 mg/kg/day) and platelet transfusions but without eVect. She was then treated with intravenous gammaglobulin (1 g/kg/day) which raised her platelet count to 45 × 10 9 /l and maintained on cyclosporin A (5 mg/kg/day) and prednisone (60 mg/day) as an outpatient. Her platelet counts remained between 400 and 680 × 10 9 /l. A colonoscopy, one month after discharge, revealed no active Crohn's disease. However, two months later, the return of active colitis prompted the addition of mesalamine to her regimen. One month later, she developed an inflammatory colonic mass necessitating left hemicolectomy. Histology of the mass was consistent with severely active Crohn's colitis. She remained asymptomatic, with normal platelet counts and did not require immunosuppressive medication. DiscussionThere are multiple case reports in the literature describing the association of inflammatory bowel disease with extraintest...

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.…”

Lactococcus garviae Endocarditis: Case Report

“…En sık endokardit (doğal ya da prostetik kalp kapakçığı zemininde olguları, sekiz olgu) olmak üzere, kaynağı belli olmayan bakteriyemi (iki olgu), osteomiyelit (bir olgu), karaciğer apsesi (bir olgu) ve bir peritonit olgusu bildirilmiştir. 6,8 Dünya'da bildirilen bazı L. garviae endokarditi olgularının tedavi şemaları ve tedavi sonrasında hastaların prognozu Tablo 1'de özetlenmiştir. Hastamızın yakın dönemde hastaneye yatışı ve penisilin allerjisi nedeniyle tedaviye vankomisin ve gentamisin kombinasyonu ile başlandı, ardından böbrek fonksiyonlarının bozulmasıyla birlikte tek başına vankomisin ile devam edildi.…”

First Report of a Hip Prosthetic and Joint Infection Caused by Lactococcus garvieae in a Woman Fishmonger

“…Nevertheless, microbiological diagnosis has been improved by molecular identification, such as PCR for 16S rRNA gene amplification. The most common infection is infective endocarditis, occurring in seven out of 11 reported L. garvieae-infected patients (6,8,10,12,19,20,21), followed by bacteremia in two out of 11 patients (20), osteomyelitis in one out of 11 (10), liver abscess in one out of 11 (13), and peritonitis in one out of 11 cases reported (20). However, L. garvieae had not yet been described as a cause of prosthetic joint infection.…”