Infective endocarditis due to Citrobacter koseri following testicular trauma: case report and literature review

Abstract

Infective endocarditis (IE) is a condition with low prevalence but high mortality rates within intensive care units. Microbiologically, most cases are attributed to Gram-positive cocci, while Gram-negative bacilli are less commonly involved. This case report describes a patient with IE caused by Citrobacter koseri (C. koseri) with secondary bacteremia due to blunt testicular trauma and epididymitis. We conducted a review of the literature to assess the clinical and associated risk factors of this underreported condition. Elderly and urinary tract infections could be associated with this entity. Cefazolin was used as the final targeted treatment. The use of precision medicine in IE is required for specific interventions.

Keywords: Citrobacter koseri; case report; epididymitis; infective endocarditis; risk factors.

Figure 1.

Cerebral MRI. (a, b) T2 weighted and FLAIR – right pontine infarction (red arrow). (c, d) T2 weighted and FLAIR – subcortical and deep white matter hyperintensities compatible with multiple septic embolisms (red arrows). FLAIR, fluid attenuation inversion recovery; MRI, magnetic resonance imaging.

Figure 2.

Transesophageal echocardiogram. (a, b) Two masses, one measuring 19 mm × 8 mm and the other 13 mm × 9 mm, are attached to the atrial wall of the mitral valve (red arrows). (c) Three-dimensional image of the mitral valve mass (red arrow). (d) Severe mitral valve insufficiency (yellow arrow).