P110 – 2513: Kingella kingae cerebral abscesses secondary to endocarditis following chickenpox: A case report

Abstract

Introduction Kingella kingae endocarditis is an extremely rare but severe infection in childhood which may occur following chickenpox. It is associated with neurological complications and high morbidity, especially if not recognised promptly. Case A previously healthy 11 month old boy presented very unwell with fever and lethargy 7 days after the development of chickenpox. He was covered with IV ceftriaxone for suspected secondary bacterial sepsis. As he improved with the antibiotics, he was noted to have asymmetrical crawling with extension of his right leg. A soft grade 1/6 murmur was present on examination. Brain MRI demonstrated multiple bilateral cerebral abscesses, which appeared embolic in nature. CSF analysis was normal but blood cultures isolated the growth of Kingella kingae. An urgent cardiac ECHO revealed a large embolic mitral valve vegetation requiring rapid surgical intervention. His immunodeficiency screen was unremarkable. He is now neurologically back to his normal self but has significant residual mitral valve regurgitation, and remains under cardiac surveillance. Discussion Kingella kingae is a gram negative bacillus which is part of the normal upper respiratory tract flora. Pathogenic cases are starting to be identified over recent times, especially in children. The risk of severe bacterial infections following chickenpox has been established in literature previously. Endocarditis is a rare complication of Kingella and there are less than 10 reported cases in literature of Kingella endocarditis affecting a native valve in children under the age of 2 years. The detection of Kingella in the bloodstream should therefore never be discounted without further investigations. Conclusion Our case highlights the importance of recognising Kingella kingae endocarditis in a child presenting with fever and neurological complications following recent chickenpox. A cardiac ECHO should be considered despite normal cardiac examination to look specifically for endocarditis secondary to this pathogen, and urgent management tailored accordingly.