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Published on: January 7, 2019
[Gemella endocarditis: an aggressive entity]
Ana Rita Godinho1, Elisa Tomé2, Ana Vaz2
1Serviço de Cardiologia, Hospital de São João, Porto, Portugal.
Abstract:
The authors present a rare case of subacute endocarditis caused by Gemella morbillorum. A 72-year-old man, with a history of hypertension, aortic valve disease and upper and lower endoscopy six months previously, was admitted due to fever and abdominal pain. He also complained of long-standing dyspnea on exertion and petechiae on his lower limbs. Imaging scans showed a consolidation in the lower left lung field, a splenic infarct and a left subphrenic abscess. Transthoracic echocardiogram findings were highly suggestive of endocarditis affecting three valves, with destruction of the mitral valve anterior leaflet. G. morbillorum was identified in three blood cultures and was considered the etiologic pathogen. Due to the patient's worsening condition, he underwent cardiac surgery, aiming to control the infection and to resolve the associated mechanical complications. This case highlights the need for a complete and thorough history to arrive at likely diagnostic hypotheses that, together with complementary exams, will lead to correct diagnosis and the prompt institution of appropriate therapy.
Insights
This case study details a rare subacute endocarditis infection caused by Gemella morbillorum. Prompt diagnosis and surgical intervention were crucial for managing this severe cardiac and systemic infection.
Area of Science:
- Infectious Diseases
- Cardiology
- Internal Medicine
Background:
- Subacute endocarditis is a serious infection affecting heart valves.
- Gemella morbillorum is a rare cause of infective endocarditis, often associated with specific patient risk factors.
Observation:
- A 72-year-old male presented with fever, abdominal pain, dyspnea, and petechiae.
- Imaging revealed lung consolidation, splenic infarct, and subphrenic abscess.
- Echocardiography indicated endocarditis on three valves, including mitral valve leaflet destruction.
Findings:
- Blood cultures confirmed Gemella morbillorum as the causative pathogen.
- The patient exhibited signs of severe systemic infection and cardiac compromise.
- Despite initial symptoms, the patient's condition deteriorated, necessitating surgical intervention.
Implications:
- This case underscores the importance of thorough patient history and diagnostic workup for rare pathogens.
- Early identification and management of Gemella morbillorum endocarditis are critical for patient outcomes.
- Multidisciplinary care involving cardiology, infectious diseases, and surgery is essential for complex endocarditis cases.
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