SHM Converge Scientific Abstract ePoster Gallery-Lactobacillus Bacteremia and Endocarditis Presenting as a Lower Extremity Rash

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This case describes a 55-year-old man with prior intravenous drug use, bioprosthetic aortic valve replacement, and prior endocarditis who developed a few weeks of lower extremity rash, malaise, low-grade fevers, and shortness of breath. Exam revealed a new murmur. He had recently stopped suppressive Bactrim and had undergone a dental procedure one month earlier without antibiotic prophylaxis.<br /><br />Initial workup showed elevated ESR and CRP with negative autoimmune and hepatitis testing. Blood cultures grew Lactobacillus species, a rare cause of bacteremia and endocarditis. CT angiography demonstrated a peri-aortic root abscess, and transesophageal echocardiography confirmed bioprosthetic aortic valve endocarditis with perivalvular abscess. Skin biopsy of the rash showed leukocytoclastic vasculitis.<br /><br />The patient was treated with IV antibiotics and underwent repeat surgical aortic valve replacement. His rash resolved and blood cultures cleared.<br /><br />The report highlights that Lactobacilli are normal flora of the mouth, gastrointestinal tract, and genitourinary tract, but can rarely cause serious infections such as bacteremia and endocarditis, especially in patients with valvular disease, prosthetic valves, recent dental work, invasive procedures, probiotic use, or immunosuppression. Lactobacillus endocarditis carries substantial morbidity and mortality, with many patients requiring valve surgery. Most isolates are penicillin-sensitive, and treatment typically involves several weeks of IV penicillin G or an aminopenicillin, with clindamycin as an alternative in penicillin-allergic patients.<br /><br />The key takeaway is that a new vasculitic-appearing rash, particularly in a patient with cardiac risk factors and recent dental work, should prompt evaluation for bacteremia and endocarditis.

Asset Subtitle

James R. Watson

Meta Tag

Author List James R. Watson, Suchita Sata, Tara Spector

Category Clinical Vignettes

Concept Lactobacillus

Concept Infective Endocarditis

Concept Lactobacillus Endocarditis

Concept Bacteremia

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author James R. Watson

Track Adult

Keywords

Lactobacillus bacteremia

infective endocarditis

bioprosthetic aortic valve

peri-aortic root abscess

leukocytoclastic vasculitis

dental procedure

prosthetic valve infection

intravenous drug use

blood cultures

IV antibiotics

Lactobacillus

Infective Endocarditis

Lactobacillus Endocarditis

Bacteremia

Blood Culture