A Rare Case of Corynebacterium Endocarditis

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A 26-year-old gentleman presented with a 1-month history of fevers, malaise and weight loss. He was born in China and had moved to Australia during his childhood. He was appropriately vaccinated. There was no history of recent dental procedures or illicit drug use. On examination, the temperature was 39 °C. Heart rate, blood pressure and oxygen saturations were normal. There was a pan-systolic murmur over the apex. There were small, non-tender, erythematous macules over both palms consistent with Janeway lesions. Neurological examination was unremarkable. Blood tests revealed raised inflammatory markers (C-reactive protein 87 mg/L). Four separate sets of blood cultures at admission isolated Corynebacterium pseudodiphtheriticum, sensitive to penicillin. Urgent transthoracic echocardiography revealed a large vegetation (11 × 9 mm) attached to the anterior mitral leaflet with associated moderate-severe regurgitation. Left ventricular function was preserved. The patient was commenced on empirical therapy for endocarditis, subsequently rationalised to intravenous benzylpenicillin. Embolic workup revealed multiple cerebral lesions suspicious for mycotic aneurysms and a small subacute infarction in the right frontal lobe. He underwent mechanical mitral valve replacement after 2 weeks of intravenous antibiotic therapy. Valve tissue and subsequent blood cultures were negative and the patient was discharged home following a 6-week admission.