SHM Converge Scientific Abstract ePoster Gallery-Lactobacillus Jensenii Causing Aortic Valve Infective Endocarditis: A Case Report

Pdf Summary

This case report describes a rare instance of native aortic valve infective endocarditis caused by <em>Lactobacillus jensenii</em> in a 57-year-old woman with uncontrolled diabetes, hypertension, and prior stroke. She presented with four days of nausea, vomiting, watery diarrhea, fever, and chills. Initial evaluation showed leukocytosis, hyperglycemia, acute kidney injury, and markedly elevated troponin. Imaging studies were unremarkable, and she was initially treated for sepsis with IV fluids, insulin, vancomycin, and piperacillin-tazobactam, along with aspirin and heparin for possible myocardial injury.

Because endocarditis was considered, a transthoracic echocardiogram was performed but showed no vegetation. Blood cultures later grew <em>Lactobacillus</em> species, prompting a change to IV ampicillin. Given the association between lactobacillemia and endocarditis, transesophageal echocardiography was obtained and revealed a 0.4 x 0.5 cm mass on the aortic valve consistent with vegetation. Additional history identified increased consumption of grapes and strawberries, possible sources of colonization, but no other major risk factors such as probiotic use, dental procedures, or immunodeficiency.

The patient was not a surgical candidate because of the small valve lesion and was managed medically with a six-week course of IV penicillin and gentamicin. She improved clinically, and follow-up blood cultures were negative. Post-discharge coronary CT angiography showed the aortic valve mass remained stable at 0.5 cm.

The report emphasizes that <em>Lactobacillus</em> endocarditis is extremely uncommon, with only about 50 reported cases overall and 11 involving <em>L. jensenii</em>. It highlights the importance of transesophageal echocardiography when endocarditis is suspected and notes that lactobacilli are usually penicillin-sensitive but often vancomycin-resistant, making early culture-guided therapy essential.

Asset Subtitle

Hamam Aneis

Meta Tag

Author List Ayse Keskinkilic, Emmanuel Frempong-Manso, Hamam Aneis

Category Clinical Vignettes

Concept Lactobacillus jensenii

Concept Infective Endocarditis

Concept Lactobacillus bacteremia

Concept Transesophageal Echocardiography

Concept Aortic Valve

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center

Presenting Author Hamam Aneis

Track Adult

Keywords

Lactobacillus jensenii

infective endocarditis

native aortic valve

transesophageal echocardiography

blood cultures

penicillin therapy

gentamicin

diabetes mellitus

aortic valve vegetation

vancomycin resistance

Lactobacillus jensenii

Infective Endocarditis

Lactobacillus bacteremia

Transesophageal Echocardiography

Aortic Valve