Lactococcus endocarditis after Bentall procedure presenting with intracranial hemorrhage

Area of Science:

• Cardiology
• Infectious Diseases
• Neurosurgery

Background:

• Endocarditis is a known complication in patients with cardiac prostheses.
• The Bentall procedure replaces the aortic valve, root, and ascending aorta, with coronary artery re-implantation.

Observation:

• A 65-year-old male with a history of atrial fibrillation, bicuspid aortic valve, and prior Bentall procedure presented with stroke symptoms.
• Imaging revealed an intracranial hemorrhage and a middle cerebral artery aneurysm.
• Blood cultures identified *Lactococcus garvieae*, and transesophageal echocardiogram showed aortic valve thickening and vegetation.

Findings:

• The patient underwent rivaroxaban reversal, cerebral angiography with embolization, and treatment for *Lactococcus garvieae* endocarditis.
• The endocarditis was associated with a prosthetic valve and presented with a mycotic aneurysm.
• Treatment involved six weeks of intravenous ceftriaxone and gentamicin.

Implications:

• This case underscores the importance of considering uncommon pathogens in prosthetic valve endocarditis.
• Early diagnosis and appropriate antibiotic therapy are crucial for managing infective endocarditis and associated complications like mycotic aneurysms.