Endocarditis by Streptococcus pasteurianus

Area of Science:

• Cardiology
• Infectious Diseases
• Internal Medicine

Background:

• Infective endocarditis (IE) diagnosis is complex due to variable presentations and nonspecific symptoms.
• Unusual etiological agents can further complicate IE diagnosis, requiring a high index of suspicion.
• The case involves a female patient with a history of bicytopenia, severe aortic stenosis, and rheumatoid arthritis.

Observation:

• The patient presented with asthenia and general malaise over several consultations.
• Streptococcus pasteurianus was initially isolated in a blood culture but not valued.
• The patient was re-hospitalized months later with recurrent symptoms.

Findings:

• Repeat blood cultures confirmed Streptococcus pasteurianus isolation.
• Splenic infarctions and transthoracic echocardiography indicated probable endocarditis.
• Transesophageal echocardiography confirmed the diagnosis of infective endocarditis.

Implications:

• This case underscores the importance of recognizing Streptococcus pasteurianus as a potential IE pathogen.
• Prompt and accurate diagnosis, even with initially overlooked findings, is vital for effective treatment.
• Surgical intervention was necessary to address the perivalvular abscess and aortic prosthesis.