Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve

Infective endocarditis caused by Gemella morbillorum is a very rare occurrence and only a few cases have been reported in the literature so far. We describe a case of G. morbillorum endocarditis in a 31-year-old Pakistani woman who had a congenitally bicuspid aortic valve. She had also undergone repair of a large aortic aneurysm 1 year before this presentation. She presented to our institution with a 1.5-month history of fever, exertional dyspnea and generalized edema. A transthoracic echocardiogram showed two large, echogenic and mobile vegetations (7 x 15 mm and 8 x 10 mm) attached to the right coronary cusp and non-coronary cusp. Blood cultures of the patient grew pan-sensitive G. morbillorum. The patient fulfilled the Duke's criteria for infective endocarditis. She was successfully treated with ceftriaxone and gentamycin therapy. At two years' follow up she has remained well. This case represents a rare cause of infectious endocarditis that was successfully managed with medical treatment alone in a patient with the predisposing risk factor of a bicuspid aortic valve.