Abstract 16207: An Uncommon Pathogen Causing Endocarditis and Valve Abscess: Aerococcus Sanguinicola

Abstract

Introduction: Aerococcus Sanguinicola is a rare pathogen associated with urinary tract infections (UTI). Widespread use of MALDI-TOF can better differentiate Aerococcus species and has led to the identification of A. Sanguinicola as a source of endocarditis. Case Presentation: A 55-year-old male with a history of diabetes mellitus and recent cystitis presented to the hospital with confusion, back pain, fever, chills and myalgias. The patient was tachycardic and hypotensive on exam. Leukocyte count was at 16 k/ul with elevated inflammatory markers. Blood cultures were obtained and empiric vancomycin and cefepime were initiated. Transthoracic echocardiogram revealed mild mitral regurgitation. On hospital day 3, gram stain demonstrated gram positive cocci in clusters, and physical exam revealed a new 3/6 holosystolic murmur in the left 6th intercoastal space. Transesophageal echocardiogram demonstrated acute severe mitral regurgitation and multiple large vegetations with abscess on the anterior leaflet (Figure). Gentamycin was added to treat presumed Staphylococcus Aureus endocarditis. Subsequent species identification revealed A. Sanguinicola as the blood-based pathogen. He underwent bioprosthetic mitral valve replacement due to acute heart failure. Anatomic pathology of the valve confirmed A. Sanguinicola infection. He completed a 6-week course of antibiotics. On his follow up visit at 3 months, the patient had recovered. Conclusion: This case demonstrates a severe case of A. Sanguinicola endocarditis requiring urgent valve replacement. A. Sanguinicola is known to generate biofilms, which are activated by plasma which contrasts with S. Aureus, for which A. Sanguinicola can be mistaken. Additionally, known case of A. Sanguinicola infection demonstrate B-lactams sensitivity. While the organism has the potential to form abscesses, we present the first reported case of valvular abscess that was successfully cured with antibiotics and surgery.