A rare case of Aerococcus urinae infective endocarditis in an atypically young male: case report and review of the literature

Abstract

Background: Aerococcus urinae is a gram-positive, alpha-hemolytic coccus bacterium primarily implicated in less than 1 % of all symptomatic urinary tract infections. Risk factors for disease include male gender, advanced age, and comorbid genitourinary tract pathology. Infections beyond the genitourinary tract are rare, though spondylodiscitis, perineal abscesses, lymphadenitis, bacteremia, meningitis, and endocarditis have been reported. Less than fifty cases of A. urinae infective endocarditis (IE) have been described in the literature. The rare occurrence of A. urinae in human infections and resultant lack of randomized controlled trials have resulted in a significant degree of clinical uncertainty in the management of A. urinae IE.

Case presentation: We present an unusual case of a forty-three year-old male with A. urinae infective endocarditis (IE) who was successfully treated with mitral valve replacement and six weeks of penicillin/gentamicin therapy. In addition, we include a comprehensive review of all reported cases of IE due to A. urinae with specific attention to therapeutic regimens and treatment durations.

Conclusion: Recent advances in diagnostic technology have led to an increase in the frequency A. urinae is diagnosed. Reviewing cases of Aerococcus urinae infections, their clinical courses and subsequent management can assist future healthcare providers and their patients.

Keywords: Aerococci; Aerococcus urinae; Infective endocarditis.

Fig. 1

Transthoracic Echocardiogram revealing large, mobile vegetation on mitral valve

Fig. 2

Intraoperative view of mitral valve vegetation on first inspection

Fig. 3

Vegetation manipulated forward, displaying firm attachment to the anterolateral commissure of mitral valve

Fig. 4

Mitral valve leaflets and chordae with architectural distortion from infection