Ahmed Abuzaanona
Henry Ford Hospital, USA
Title: Vagococcus fluvialis causing severe infective endocarditis presenting with embolic stroke; A case report
Biography
Biography: Ahmed Abuzaanona
Abstract
Introduction:
Infective endocarditis (IE) is most commonly caused by staph, streptococcus or enterococcus species. Vagococcus is a distinct genus that has been identified in 1989. One case of human infection was reported causing periodontal abscess. We report the first case of IE caused by Vagococcus fluvialis involving both aortic and mitral valves, presenting as an embolic stroke and requiring surgical intervention.
Case presentation:
A 34 year old female with a history of intravenous drug abuse and endocarditis presented with headache, fever and new onset blind spots after two weeks of toothache and purulent discharge in her oral cavity. On exam she was septic, with new left sided facial weakness, inferior quadranopsia and an apical pansystolic murmur. MRI of the brain showed subacute right occipitoparietal infarct. TEE then revealed mobile vegetations involving aortic and mitral valves, causing severe aortic and mitral insufficiency with ulceration of two of the aortic cusps, and felt to be the source of her embolic stroke. She was started on vancomycin and gentamycin, then switched to intravenous ampicillin and ceftriaxone after blood culture growth of Vagococcus fluvialis. She underwent bioprosthetic valve replacement of both valves with repair of aortic defect with pericardial patch four weeks into her treatment, and received 6 total weeks of antibiotics with resolution of her symptoms on follow up.
Discussion:
Embolic stroke due to IE should always be considered in patients presenting with neurological deficit in the setting of poor dentition and intravenous drug abuse. Vagococcus fluvialis appears to have a fulminant course when causing IE.
