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. 2025 Jan 17;18(1):17.
doi: 10.1186/s12245-025-00814-6.

A case of stroke as a unique sign of subclinical infective endocarditis by Abiotrophia defectiva: a case report

Silvia Puxeddu  1 , Valeria Virdis  2 , Daniele Sacco  2 , Mario Depau  3 , Alessandro M Atzei  4 , Lorella Pisano  5 , Marcello Di Rosa  2 , Stefania Vacquer  2 , Giorgio Accardi  6 , Emiliano M Cirio  5 , Aldo Manzin  1 , Cristiana Marinelli  2 , Fabrizio Angius  7
Affiliations

A case of stroke as a unique sign of subclinical infective endocarditis by Abiotrophia defectiva: a case report

Silvia Puxeddu et al. Int J Emerg Med. .

Abstract

Purpose: Here we describe a patient admitted for a stroke that was unexpectedly correlated with subclinical infective endocarditis attributable to a rarely opportunistic pathogen, Abiotrophia defectiva.

Case report: A 75-year-old man presented with a stroke. Transesophageal echocardiography suggested vegetation on all aortic valve cusps, despite the absence of clinical or laboratory signs of infection. Surprisingly, three sets of blood cultures collected without fever were positive for A. defectiva. Although the patient did not exhibit classic signs of infection during hospitalization, the severity of the valve condition necessitated replacement with a bioprosthesis.

Conclusions: This clinical case underscores the importance of investigating the infective origin of endocarditis, even in the absence of clinical or laboratory evidence. Physicians should maintain a high level of suspicion, especially in patients with highly suggestive anamnestic characteristics.

Keywords: Abiotrophia defectiva; Blood cultures; Case report; Infective endocarditis; MALDI-TOF; Valve replacement.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was not required for the study involving humans in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and the institutional requirements. Consent for publication: The patient’s written consent was obtained for the publication of any potentially identifiable images or data included in this article and for the publication of this case report. Competing interests: The authors declare no competing interests. Clinical Trial: Not applicable.

Figures

Fig. 1
Fig. 1
Historical and information timeline from this case
Fig. 2
Fig. 2
Transesophageal echocardiogram (TEE) imaging indicating the presence of a linear image with passive movement adherent to the non-coronary cusp (about 8 mm) associated with other small images on the other two cusps, compatible with endocardial vegetations on the prosthetic cusps
Fig. 3
Fig. 3
(A) Peripheral blood smear by Walk Away Specimen Processor (WASP) highlighting the presence of Gram-positive cocci organized in chains (red arrows). (B) Chocolate Agar + PolyVitex® Biomerieux culture medium with A. defectiva visible growth. Colonies appear surrounded by a halo with greenish fuzzy contours. Antibiogram was performed by E-TEST method inoculating a pure culture of A. defectiva on Chocolate Agar + PolyVitex® Biomerieux. The susceptibility was evaluated against (C) ciprofloxacin (CI), gentamicin (GM), (D) levofloxacin (LE) and piperacillin/tazobactam (PT), (E) amikacin (AK) and aztreonam (AT), (F) tobramycin (TM) and ticarcillin/clavulanic acid (TLc)
See this image and copyright information in PMC

References

    1. Pallotto C, Martinelli L, Baldelli F, Bucaneve G, Cecchini E, Malincarne L, et al. Trends in Infective endocarditis in a Medium-Sized University Hospital in Italy: analysis of 232 cases. Infez Med. 2014;22(2):124–31. Epub 2014/06/24. - PubMed
    1. Galar A, Weil AA, Dudzinski DM, Munoz P, Siedner MJ. Methicillin-Resistant Staphylococcus Aureus Prosthetic Valve Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev (2019) 32(2). Epub 2019/02/15. 10.1128/CMR.00041-18 - PMC - PubMed
    1. Poruban T, Hunavy M, Farkas D, Carnoky S, Jakubova M. A rare Serratia Marcescens-Associated Acute endocarditis of a tricuspid valve in an intravenous drug user: a Case Report and Literature Review. Wien Klin Wochenschr. 2023;135(21–22):631–6. 10.1007/s00508-023-02217-0. Epub 2023/05/31. - PubMed
    1. Calderon Parra J, De Castro-Campos D, Munoz Garcia P, Olmedo Samperio M, Marin Arriaza M, De Alarcon A, et al. Non-hacek Gram Negative Bacilli Endocarditis: analysis of a national prospective cohort. Eur J Intern Med. 2021;92(71–8). 10.1016/j.ejim.2021.04.021. Epub 2021/05/14. - PubMed
    1. Morpeth S, Murdoch D, Cabell CH, Karchmer AW, Pappas P, Levine D, et al. Non-hacek Gram-negative Bacillus endocarditis. Ann Intern Med. 2007;147(12):829–35. 10.7326/0003-4819-147-12-200712180-00002. Epub 2007/12/19. - PubMed

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