Staphylococcus lugdunensis Endocarditis Presenting with Brain Abscesses and Temporal Vision Deficits

Abstract

Staphylococcus lugdunensis is a coagulase-negative staphylococcal bacterium (CoNS) that colonizes the skin. While infectious endocarditis (IE) caused by S. lugdunensis is rare, it is noteworthy because it has been associated with an aggressive clinical course. In this report, we present a case of culture-negative IE complicated by brain abscesses, vision deficits, and progressive heart failure that ultimately required mitral valve replacement. The causative agent was eventually identified as S. lugdunensis through molecular testing of valvular tissue.

Figure 1

(a) Axial and (b) sagittal views of initial MRI imaging displayed left frontal, occipital, and parietal lobe abscesses with leptomeningeal enhancement.

Figure 2

The patient's initial CT scan of the chest, abdomen, and pelvis was remarkable for infarcts in the spleen and bilaterally in the kidneys.

Figure 3

(a) Transthoracic echocardiography (TTE) and (b) follow-up transesophageal study (TEE) demonstrating a density (identified by arrow in (b)) on the mitral valve.

Figure 4

Repeat (a) axial and (b) sagittal views of MRI imaging after 12 weeks of antibiotic therapy demonstrated resolving left frontal, occipital, and parietal lobe abscesses.