Enterococcus durans endocarditis with prosthetic valve and implantable electronic device and literature review

Enterococcus durans is an extremely rare cause of infectious endocarditis. To date, only nine cases of endocarditis or cardiac implantable electronic device (CIED) infection due to E. durans have been reported in the literature. A 48-year-old man with hypertension, non-ischemic dilated cardiomyopathy, previous aortic valve replacement and cardiac resynchronisation implantation with defibrillator presented with weakness, anorexia, nausea, vomiting and weight loss for 7 months. Transthoracic echocardiography showed a 10 mm mobile vegetation on the aortic valve. Ampicillin and gentamicin-sensitive Enterococcus durans was grown in 3 sets of blood-cultures within 24-72 hours of admission. The patient who developed septic embolism complication was successfully treated with gentamicin and ampicillin for 6 weeks. Enterococcus durans is an extremely rare cause of infectious endocarditis whose risk factors, natural history and response to treatment remain unclear. This rare and potentially high mortality infectious agent should be kept in mind in patients with bioprosthetic-valves and CIED.