Unusual Presentation of Streptococcus uberis Bacteremia in a Complex Patient: A Case Report

Streptococcus uberis (S. uberis), primarily recognized as a pathogen in bovine mastitis, rarely causes infections in humans. Here, we present a case of S. uberis bacteremia in a 58-year-old male patient with multiple comorbidities, including end-stage renal disease (ESRD) on hemodialysis, type 2 diabetes mellitus, and a history of tricuspid valve endocarditis. The patient presented with generalized weakness, fatigue, and diarrhea, alongside intermittent chills and elevated heart rate during hemodialysis. Initial evaluation revealed severe sepsis with elevated lactic acidosis and abnormal cardiac biomarkers. Blood cultures confirmed S. uberis bacteremia, prompting empirical treatment with vancomycin and cefepime adjusted for dialysis clearance. A transthoracic echocardiogram (TTE) was performed to evaluate for infective endocarditis. The patient responded well to antibiotic therapy, with the resolution of fever and inflammatory markers. Subsequent investigations, including a transesophageal echocardiogram (TEE), did not reveal valvular vegetations. The patient completed six weeks of vancomycin therapy and was advised on outpatient follow-up for further management. This case highlights the diagnostic challenges and therapeutic considerations in managing S. uberis bacteremia in immunocompromised individuals. Despite the bacterium's primary association with dairy cattle, our patient's lack of direct contact underscores the potential for zoonotic transmission through environmental exposures. Effective management included prompt initiation of appropriate antibiotics guided by susceptibility testing and a comprehensive evaluation for infective endocarditis. Further research is needed to elucidate optimal management strategies for S. uberis infections in vulnerable patient populations.