Leuconostoc species endocarditis in an intravenous drug user

Abstract

Infective endocarditis is a potentially lethal infection, which predominantly affects the atrioventricular valves. Rapid identification and management is critical to reduce morbidity and mortality in this patient population. Herein, we present a case of a 24-year-old man with Leuconostoc species infective endocarditis of the aortic valve. Disease course was complicated by several septic emboli to the brain, central retinal artery, and spleen. This case serves to remind clinicians that Leuconostoc species, which are typically not pathogenic to human species, can cause infective endocarditis in individuals with a history of intravenous drug use. <Learning objective: It is crucial that clinicians maintain a high index of suspicion in high-risk patients for infective endocarditis with Leuconostoc species, especially in the setting of positive blood cultures with group viridans streptococcus resistant to penicillin. Although cases of penicillin resistant group viridans streptococci have been reported, it is not common and merits further review. Leuconostoc is a Gram-positive ovoid cocci that is intrinsically vancomycin-resistant and is typically non-pathogenic to the human species.>.

Keywords: Infective endocarditis; Leuconostoc; Septic emboli.

Fig. 1

Magnetic resonance imaging (MRI) without contrast of the brain showing a focal area of hypo-attenuation seen on T2, fluid attenuated inversion recovery, and diffusion weighted imaging sequences within the subcortical left frontal lobe measuring 6 mm. The focus is hyper-intense on T1 non-contrast MRI.

Fig. 2

Transthoracic echocardiography showing a bicuspid aortic valve with moderate valve stenosis and bacterial vegetation.

Fig. 3

Diagnostic cerebral angiogram showing left distal middle cerebral artery M2 branch aneurysm measuring 6.89 × 5.29 mm in the Sylvian fissure (A, B, C). Repeat cerebral angiogram showing no residual aneurysm in the left middle cerebral artery territory with embolization coil seen in the Sylvian fissure (D).