A RARE CASE OF CORYNEBACTERIUM STRIATUM NATIVE VALVE ENDOCARDITIS

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Corynebacterium diphtheroids species are aerobic, Gram-positive bacilli often considered as part of normal skin flora and mucous membranes. Though frequently isolated in cultures, they are often assumed to be skin contaminants. Nonetheless, over the last decade they are reported to cause life threatening diseases including bacteremia and endocarditis. They cause 4-9% of prosthetic vale endocarditis but are only responsible for 0.2 to 0.4% of native valve endocarditis (NVE)(1). CASE PRESENTATION: 54 years old female with past medical history significant for hypertension, hyperlipidemia, mild intermittent asthma, anemia, seizure disorder, transient ischemic attack, cerebrovascular accident without any residual deficit, atrial fibrillation on coumadin, schizophrenia, chronic back pain, cocaine use, recent colitis presented with complains of intermittent fever, chills for few weeks and mechanical fall one day prior to presentation. She was recently treated for colitis at outside hospital (OH) and was discharged on oral co-amoxiclav. She reported that she had bacteremia. Vitals: temp 101.5F, Blood pressure (BP) 102/67mmhg. Physical examination: irregular heart rate, wheezing, positive cervical and lumbar paraspinal tenderness. Labs: normocytic anemia with hemoglobin of 10.4, platelet count of 115 x 109/L, sub-therapeutic international normalized ratio (INR) of 1.11 and cervical spine X-ray suggestive of disc space narrowing at C5-C6. Cefepime 1gm IVSS q8h and vancomycin 1gm IVSS q12h were started. Hospital course was complicated by hypotension with BP of 80s-90s systolic/50’s to 60’s diastolic, non-responsive to intravenous fluids and drop in oxygen saturation to 80’s due to development of pulmonary edema. Blood cultures were positive for gram positive rods. Medical records from OH revealed blood cultures positive for gram positive rods. Antibiotic was changed to ampicillin to cover possible listeria monocytogenes (blood cultures positive for gram positive rods). Transthoracic echocardiogram (TTE) was suggestive of aortic valve vegetation with severe regurgitation (See Figure 1). She was considered candidate for aortic valve replacement and transferred to cardiothoracic surgery. She successfully underwent aortic valve replacement. Final results of blood cultures grew “Corynebacterium Striatum (C. Striatum)”. DISCUSSION: This case highlights a patient with native valve endocarditis secondary to C. Striatum and its management. C. striatum is being recently recognized as a nosocomial opportunistic pathogen (2,3) and can rarely cause NVE. CONCLUSIONS: We stress that clinicians should be vigilant and consider Corynebacterium species as potential culprits while managing patients with bacteremia due to gram positive bacilli and should be cautious while labelling them as skin contaminants. Reference #1: Belmares J, Detterline S, Pak JB, Parada JP. Corynebacterium endocarditis species-specific risk factors and outcomes. BMC Infect Dis. 2007;7:4. Reference #2: Lee JY, Lee SH, Kim WH. Three-valve Endocarditis Caused by Corynebacterium striatum. Korean Circ J. 2018;48(9):861-2. Reference #3: McMullen AR, Anderson N, Wallace MA, Shupe A, Burnham CA. When Good Bugs Go Bad: Epidemiology and Antimicrobial Resistance Profiles of Corynebacterium striatum, an Emerging Multidrug-Resistant, Opportunistic Pathogen. Antimicrob Agents Chemother. 2017;61(11). DISCLOSURES: No relevant relationships by Moses Bachan, source=Web Response No relevant relationships by Zinobia Khan, source=Web Response No relevant relationships by Dileep Kumar, source=Web Response