Mycobacterium neoaurum rarely causes bacteremia, and infection usually occurs in immunocompromised hosts. Prosthetic Valve Endocarditis (PVE) due to Non Tuberculous Mycobacteria (NTM) is rare; Mycobacterium neoaurum has never been implicated in this disease. We report a case of Mycobacterium neoaurum prosthetic valve endocarditis with favorable response to therapy. *Corresponding author: AnupamKumar, University of Connecticut Health Center, 263 Farmington Ave Farmington, 06030 CT, USA, E-mail: drkumar83@gmail.com Received January 28, 2013; Accepted August 23, 2013; Published August 25, 2013 Citation: Anupam Kumar (2013) Mycobacterium neoaurum Causing Prosthetic Valve Endocarditis. J Pulmon Resp Med S14: 006. doi:10.4172/2161-105X.S14006 Copyright: © 2013 Anupam Kumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Case Report A 30 year old Caucasian male presented to the emergency department with shortness of breath and palpitations of 2 weeks duration associated with fever and chills. His past medical history was significant for multiple episodes of MRSA endocarditis in the setting of intravenous drug use, for which he had undergone bovine mitral valve replacement a year prior. He admitted to continued intravenous drug use despite recurrent endocarditis and valve replacement. His vital signs on admission were temperature of 101.4°F, pulse rate of 106 per minute, blood pressure of 98/58 mm Hg and respiratory rate of 20 per minute. A Grade 3/6 holosystolic murmur was heard best at the mitral area and radiated to the axilla. The lower extremities were warm to touch. Distal pulses were intact and symmetric. A detailed neurological exam was unremarkable. Admission laboratory tests showed a WBC count of 16.8K/mm3 with neutrophil predominance (84%). Serum electrolytes, blood urea nitrogen, creatinine, creatine kinase (CK) and liver function tests were within the normal range. Chest x-ray showed no abnormality, and electrocardiogram showed normal sinus rhythm with mild left atrial enlargement. Blood cultures were drawn and the patient was started on empiric antibiotic therapy with vancomycin, ceftriaxone and rifampin for provisional diagnosis of prosthetic valve endocarditis. A transthoracic echocardiogram revealed extensive vegetations on the prosthetic mitral valve with mild obstruction to mitral inflow and a normal ejection fraction (Figure 1). The gram stain of the blood smear was initially reported as rods with both gram positive and gramnegative characteristics (Figure 2). However, the acid-fast stain turned positive and three blood culture bottles (aerobic) eventually grew Mycobacterium species (Figure 3). The organism was further identified as Mycobacterium neoaurum using the 16s ribosomal DNA sequencing method. The patient was treated with an anti-mycobacterial regimen based on susceptibility data: IV tobramycin, oral azithromycin and oral moxifloxacin. On day ten of his hospital stay he developed severe abdominal pain. CT scan of the abdomen revealed a splenic infarct (Figure 4) as well as left renal infarct (Figure 5). MRI of brain revealed one centimeter brain abscess (Figure 6). Surgical intervention was discouraged given his ongoing drug use. The patient’s condition Figure 1: Echocardiogram showing vegetations on the prosthetic mitral valve with mild obstruction to mitral inflow. Figure 2: Gram stain showing organism with gram positive and gram negative characteristics. Figure 3: Ziehl Neelsen staining demonstrating acid fast organisms suggestive of mycobacteria species. Citation: Anupam Kumar (2013) Mycobacterium neoaurum Causing Prosthetic Valve Endocarditis. J Pulmon Resp Med S14: 006. doi:10.4172/2161105X.S14-006