SHM Converge Scientific Abstract ePoster Gallery-Rothia Dentocariosa Endocarditis With Intracranial Mycotic Aneurysm

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This case describes a 53-year-old previously healthy man who developed <strong>Rothia dentocariosa infective endocarditis</strong> shortly after a dental procedure. He presented with acute headache, and brain MRI showed multiple microhemorrhages. Cerebral angiography identified a <strong>left posterior cerebral artery aneurysm</strong>, consistent with a <strong>mycotic aneurysm</strong>. Transthoracic echocardiography revealed severe mitral regurgitation, posterior leaflet prolapse, and a 7 mm vegetation on the anterior mitral leaflet.

Blood cultures became positive on hospital day 8 and were identified as <strong>R. dentocariosa</strong>, a rare gram-positive oral organism that can cause endocarditis. During hospitalization, the patient developed disorientation and apraxia due to seizures and progression of the aneurysm, requiring urgent <strong>endovascular coil embolization</strong>. He then completed <strong>six weeks of intravenous antibiotics</strong> and later underwent successful <strong>mitral valve repair</strong> without visible residual vegetation.

The discussion emphasizes that R. dentocariosa is a normal inhabitant of the mouth and throat but an uncommon cause of infective endocarditis, with only about 50 reported cases. Oral disease and structural valve abnormalities are major risk factors. This infection is notable for high rates of <strong>cardiac complications (about 50%)</strong>, <strong>neurologic complications (about 40%)</strong>, and <strong>mycotic aneurysm formation (about 25%)</strong>, which is much higher than in typical infective endocarditis.

The case highlights the importance of recognizing this rare pathogen and managing complications through <strong>multidisciplinary collaboration</strong> among infectious disease, neurosurgery, and cardiovascular surgery teams.

Asset Subtitle

Ryosuke Takeuchi

Meta Tag

Author List Kenji Motohashi, Manabu Yamasaki, Mikiko Ozaki, Ryosuke Takeuchi, Satoshi Kitaura, Yasuhiro Komatsu, Yoshitaka Tomoda, Yuichiro Shimoyama

Category Clinical Vignettes

Concept Rothia dentocariosa

Concept Infective Endocarditis

Concept Mycotic aneurysm

Concept Valvular Vegetation

Concept Antibiotics

Distinguished Non-Finalist

Presenter Organization Itabashi Chuo Medical Center

Presenting Author Ryosuke Takeuchi

Track Adult

Keywords

Rothia dentocariosa

infective endocarditis

mycotic aneurysm

mitral regurgitation

cerebral angiography

posterior cerebral artery aneurysm

endovascular coil embolization

intravenous antibiotics

mitral valve repair

multidisciplinary collaboration

Rothia dentocariosa

Infective Endocarditis

Mycotic aneurysm

Valvular Vegetation

Antibiotics