21 May 2020
: Case report
Aerococcus Urinae Aortic Valve Endocarditis with Kissing Aortic Wall Ulcer: A Case Report and Literature Review
Challenging differential diagnosis, Unusual setting of medical care, Rare disease
Dipesh Ludhwani1ABEF*, Jennifer Li1BEF, Edward E. Huang2DE, Anna Sikora1F, George Thomas3FDOI: 10.12659/AJCR.920974
Am J Case Rep 2020; 21:e920974
Abstract
BACKGROUND: Initially presumed as nonpathogenic, the bacterial genus aerococcus now includes 7 distinct virulent and avirulent species. Aerococcus urinae first isolated in 1992 is an uncommon cause of urinary tract infection (UTI) and is seen in only 0.15% to 0.8% of cases. A. urinae associated invasive bacteremia and systemic infection are extremely rare entities. Less than 50 cases of A. urinae associated with infective endocarditis (IE) have been reported in the literature, with the prevalence being 3 per 1 million.
CASE REPORT: A 59-year-old male presented to our hospital with exertional dyspnea and new-onset atrial flutter. Prior to his current admission patient was treated for A. urinae associated UTI with levofloxacin for 10 days. A transthoracic echocardiogram revealed severe aortic regurgitation with aortic valve endocarditis, which was subsequently confirmed on transesophageal echocardiogram. Blood cultures displayed gram-positive cocci in clusters, ultimately identified as A. urinae. The patient was treated with intravenous vancomycin and underwent surgical aortic valve replacement along with patch repair for underlying aortic wall ulcer.
CONCLUSIONS: To the best of our knowledge, this is the first-ever reported case of A. urinae associated IE complicated by an aortic wall ulcer. Male gender, age >65 years, and preexisting urinary tract pathology have all been implicated as risk factors for aerococcus infection. A. urinae is almost always sensitive to penicillin, carbapenem, and aminoglycosides.
Keywords: Aerococcus, Aortic Diseases, Aortic Valve Insufficiency, Endocarditis, Aortic Valve, Atrial Fibrillation, Dyspnea, Echocardiography, Echocardiography, Transesophageal, Risk Factors, Ulcer
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946614
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946488
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946876
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946560
Most Viewed Current Articles
21 Jun 2024 : Case report
96,182
DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report
52,159
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
20 Nov 2023 : Case report
31,026
DOI :10.12659/AJCR.941424
Am J Case Rep 2023; 24:e941424
18 Feb 2024 : Case report
23,365
DOI :10.12659/AJCR.943030
Am J Case Rep 2024; 25:e943030