SHM Converge Scientific Abstract ePoster Gallery-Gemella Endocarditis, From Dental Plaque to Heart Attack

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This case describes a 74-year-old man with 10 months of progressive shortness of breath, fatigue, nonproductive cough, dark “coke-colored” urine, and 20-pound weight loss. His history included CAD s/p CABG, aortic stenosis s/p TAVR, hypertension, hyperlipidemia, type 2 diabetes, and gout. On exam, he had a systolic murmur, trace edema, and petechial rash on the lower extremities.<br /><br />Laboratory findings showed anemia, leukocytosis, elevated creatinine, high inflammatory markers, low complement levels, and urinalysis with significant hematuria. Blood cultures initially showed gram-positive cocci in pairs and later identified Gemella. Echocardiography demonstrated mitral valve vegetation, confirming infective endocarditis. Skin punch biopsy was consistent with leukocytoclastic vasculitis. The clinical picture was most consistent with subacute bacterial endocarditis complicated by immune-mediated manifestations, including glomerulonephritis and vasculitis.<br /><br />The suspected source was a dental procedure performed 10–11 months before admission. Gemella is a rare gram-positive organism normally found in the oropharyngeal and gastrointestinal flora, accounting for about 0.4% of endocarditis cases. Diagnosis can be challenging because blood cultures may be negative in a significant proportion of cases.<br /><br />He was treated with ceftriaxone during hospitalization, then discharged on cefdinir and dalbavancin for extended therapy. Repeat blood cultures were negative. His symptoms improved shortly after discharge, and follow-up showed return of renal function to baseline and resolution of the rash.<br /><br />The case highlights that unexplained vasculitis, hematuria, rash, and constitutional symptoms should prompt evaluation for infective endocarditis, including atypical organisms such as Gemella, even when blood cultures are initially negative.

Asset Subtitle

Justin D. McGee

Meta Tag

Author List Justin D. McGee, Seth Stein

Category Clinical Vignettes

Concept Subacute Endocarditis

Concept Infective Endocarditis

Concept Gemella Species

Concept Echocardiographic Vegetation

Concept Targeted Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Central Maine Medical Center

Presenting Author Justin D. McGee

Track Adult

Keywords

Gemella endocarditis

infective endocarditis

subacute bacterial endocarditis

mitral valve vegetation

leukocytoclastic vasculitis

glomerulonephritis

hematuria

dental procedure

blood cultures negative

ceftriaxone therapy

Subacute Endocarditis

Infective Endocarditis

Gemella Species

Echocardiographic Vegetation

Targeted Antibiotic Therapy