Abstract
Arcanobacterium haemolyticum is an organism that commonly causes pharyngitis and wound infections. It does not usually cause systemic invasive disease. The organism presents a difficult diagnostic problem because the Clinical Microbiology laboratory has a propensity to view them as diphtheroid organisms of the Corynebacterium species, thus contaminants or normal flora. We describe a case of a 21-year-old female who had endocarditis with cerebral emboli due to Arcanobacterium haemolyticum. This rare condition is associated with significant mortality and to the best of our knowledge; this is the first successfully treated case of A. haemolyticum endocarditis complicated by embolic phenomenon.
Highlights
Arcanobacterium haemolyticum is a facultative anaerobic gram-positive bacillus
Classified in the Cornyebacterium genus, it was re-classified in a new genus in 1982 [1]. It has been isolated from the skin and pharynx of healthy individuals and it is a wellrecognised cause of pharyngitis, skin and soft-tissue infections [2]
Arcanobacterium means ‘mysterious bacterium’, which is an epithet quite befitting for an organism that is frequently overlooked by the Clinical Microbiology laboratory because it is deemed to be a contaminant or normal flora [8]
Summary
Arcanobacterium haemolyticum is a facultative anaerobic gram-positive bacillus. Originally classified in the Cornyebacterium genus, it was re-classified in a new genus in 1982 [1]. Case report A 21-year-old Caucasian female with known congenital heart disease presented with a five-day history of fever, lethargy and a swollen, painful left calf Neurosurgical review led to an emergency right frontal craniotomy with evacuation of the hematoma (Figure 1b), which was negative on microbiological culture She was commenced on empirical intravenous ceftriaxone (2 g every 12 h), vancomycin (1 g every 12 h) and metronidazole (500 mg every 8 h) on advice from the Microbiology Department. There have been several reports of A. haemolyticum infective endocarditis in which there have been treatment failures with penicillin [5,6,7] In view of this and the fact the patient was clinically improving, Microbiology advised continuing ceftriaxone with the addition of gentamicin (80 mg every 12 hours) to the treatment regime. The patient underwent a successful insertion of intracranial titanium plates and titanium cranioplasty nine months later
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