Lactobacillus garvieae endocarditis presenting with leg cramps

Area of Science:

• Infectious Diseases
• Cardiology
• Neurology

Background:

• Lactococcus garvieae, an aquaculture pathogen, rarely causes infective endocarditis in humans.
• Elderly and immunocompromised individuals are particularly susceptible.
• Atypical presentations of infective endocarditis can delay diagnosis and treatment.

Purpose of the Study:

• To report a case of Lactococcus garvieae infective endocarditis in an 85-year-old man.
• To discuss the challenges in diagnosing and managing this rare condition in the elderly.
• To emphasize the importance of considering unusual pathogens in atypical presentations of endocarditis.

Main Methods:

• Case report of an 85-year-old male with aortic valve replacement.
• Initial diagnosis of degenerative disc disease.
• Identification of Lactococcus garvieae infective endocarditis with septic embolic strokes.
• Treatment with intravenous antimicrobials and inpatient rehabilitation due to high surgical risk.

Main Results:

• The patient presented with lower limb cramps, initially misdiagnosed.
• Septic embolic strokes led to central poststroke pain syndrome.
• Successful treatment with a 6-week course of intravenous antimicrobials and rehabilitation.
• Cardiothoracic surgery was considered too high risk.

Conclusions:

• Lactococcus garvieae endocarditis can present atypically in the elderly.
• Early recognition and appropriate antimicrobial therapy are vital.
• This case underscores the need for a broad differential diagnosis in elderly patients with unusual symptoms and risk factors.