A case of infective endocarditis caused by Gemella sanguinis

Abstract number: R2213

Almaghrabi R., Halim M., Fadel B., Alsheikh A., Kherallah M.

Introduction: Infective Endocarditis (IE) is one of the most commonly recognized infections associated with Gemella spp. Approximately 42 cases of IE associated with Gemella spp. have been reported in the literature. Gemella sanguinis has been reported only in two cases as a cause IE.

Case summary: A 23-year-old male with history of repaired ventricular septal defect and regurgitated aortic valve and history of Behcet's disease who was admitted with the diagnosis of infective arotic valve endocarditis based on a clinical presentation of fever, right flank pain, a new diastolic murmur, mild anaemia, leukocytosis and an elevated erythrocyte sedimentation rate, supported with a positive blood culture for Gemella sanguinis and echocardiogram findings of aortic regurgitation with large mass (17×9 mm) that is attached to the right coronary cuspid of aortic valve. An embolisation to the right kidney was confirmed with a computed tomography of the abdomen revealing a wedge shaped infarction. The patient was treated with ceftriaxone and gentamicin and had a good clinical response with resolution of fever, negativity of follow up blood culture and decreased sedimentation rate. The patient had eventually died with intracranial bleed as a complication of anticoagulation that was started for hypercoagulable state associated with Behcet's disease..

Discussion: To the best of our knowledge, this is only the third report of endocarditis caused by G. sanguinis. Our patient had a predisposing cardiac disease and in the absence of other predisposing dental or periodontal diseases; we believe that his oral ulcers related to his Behcet's disease served as the entry port of the organism to the blood stream. The vegetation size is relatively lage and associated with visceral embolisation, none of the case reports that described this organism have commented on the vegetations size.

Conclusion: This case represents the first case of Gemella IE in the kingdom and the third in the literature.