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Vartan Garibyan, David Shaw
(Scripps Mercy Hospital, Graduate Medical Education, San Diego, USA)
Am J Case Rep 2013; 14:435-438
Background: Infective endocarditis remains a prominent cause of morbidity and mortality worldwide. It has been estimated that 50% of cases are caused by streptococcal organisms. Abiotrophia and Granulicatella, often grouped as nutritionally variant streptococci (NVS), have become recognized as the cause of nearly 5% of infective endocarditis cases. NVS endocarditis historically has a higher rate of morbidity and mortality, partially due to difficulties in adequately culturing and treating the causative organisms.
Case Report: In this report, we review the complicated hospital course and successful treatment of a middle aged Hispanic gentleman who presented with systemic symptoms of fevers, chills and weight loss over 3 months. He was found to have Granulicatella infective endocarditis of the mitral and aortic valves, presumably from a dental source. Despite severe valvular insufficiency noted on echocardiogram, the patient did not initially present with any symptoms of decompensated heart failure. With adequate antibiotic therapy followed by replacement of both valves, the patient had a successful recovery.
Conclusions: This case report highlights the growing role that nutritionally variant streptococcus plays in endocarditis and how crucial early identification of the organism is to proper treatment. A brief literature review is also included about the diagnosis and recommended management of nutritionally variant streptococcal endocarditis.