Abiotrophia defectiva endocarditis presenting with hemiplegia

Abstract

Abiotrophia defectiva was previously known as a member of the nutritionally variant streptococcus (NVS). This microorganism is a member of the normal flora of mouth, urogenital and intestinal tracts. It causes various infections such as bacteriemia, brain abscess, septic arthritis and rarely infective endocarditis. Only < 1% of all cases of endocarditis are caused by A. defectiva. A 23 year old previously healthy female was admitted to emergency department for left hemiplegia. On physical examination, petechial rashes were detected on her palmar and plantar regions. Magnetic resonance image of brain revealed acute enfarctus in the striatocapsuler area, and total occlusion was detected in right median common arterial segment M1 with magnetic resonance imaging angiography. Urgent thrombectomy was performed. Echocardiography demonstrated a mobile vegetation on mitral valve leaflet. Infective endocarditis was diagnosed and ceftriaxone at 2gr/day and vancomycin at 2 gr/day doses were started. A. defectiva was isolated in blood cultures. Antibiotics were changed to ampicillin/sulbactam at 8 gr/day and vancomycin at 2 gr /day doses. Infective endocarditis caused by A. defectiva and other nutritionally variant streptococci are reported to have a higher mortality, morbidity and complication rates. In the current communication we report this rather rare case of infective endocarditis.