MATTERS OF THE HEART: MULTICOMPLEX ENDOCARDITIS DUE TO ABIOTROPHIA DEFECTIVA

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Abiotrophia stands for "life nutrition deficiency," indicating that the species needs supplemented media growth and survival. This bacteria requires Vitamin B6 L-cysteine to grow it is unable in regular blood agar. creates difficulty detection of this pathogen. defectiva has been shown reside oral, upper respiratory flora, intestinal mucosa implicated culture-negative endocarditis. case report highlights complex presentation, management, complications a rare cause common disease. CASE PRESENTATION: A 66 year old male member Jehovah's Witness with history bicuspid aortic valve presented 3 month substernal chest pain, palpitations, productive cough, dyspnea fever. Physical examination was remarkable grade III systolic murmur at right 2nd intercostal space. Transthoracic echocardiogram showed an ejection fraction 40-45% valve. Blood cultures grew 4/4 bottles TEE confirmed 1.8 cm x 0.5 vegetation on cusp. The patient started empiric regimen Vancomycin Gentamicin least 6 weeks after negative cultures. declined replacement. Subsequently, MRI imaging displayed findings L4-5 disciits without epidural extension. His clinical course further deteriorated atrial fibrillation acute kidney injury which rapidly progressed tubular necrosis. He transferred new tertiary hospital where he underwent bloodless replacement any complications. DISCUSSION: A. aggressive multidrug resistant organism poor prognosis. unique unpredictable nature endocarditis, propensity devastating complications, role surgical management. defectiva's ability produce exopolysaccharide bind fibronectin extracellular matrix contribute its virulence. American Heart Association guidelines recommend treatment used Enterococcus endocarditis: Penicillin 4–6 weeks. However, 90% isolates are penicillin. alternative limited benefit. Future studies can explore whether endocarditis warrants triple antibiotic therapy. CONCLUSIONS: Infectious caused by extremely but not infrequent. should always be monitored intensive thorough manner, one's guard even higher Early suspicion, diagnosis, management fastidious microorganism vital prevent grave create better prognosis patients. REFERENCE #1: Alberti, M., Hindler, J. A., & Humphries, R. M. (n.d.). Antimicrobial Susceptibilities defectiva, Granulicatella adiacens, elegans. Retrieved July 17, 2020, from https://www.ncbi.nlm.nih.gov/pmc/ #2: CARLEO3, GIUDICE2, VIGLIETTI3, R., And, P. Aortic Valve Endocarditis Caused defectiva: Report Literature Overview. http://iv.iiarjournals.org/content/29/5/515.full #3: Rudrappa, Kokatnur, L. (2017). Infective Due Its Feared Complications Immunocompetent Person: Rare, But Real. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452557 DISCLOSURES: no disclosure file Frederick Afari; No relevant relationships Karen Antwiler, source=Web Response Anna Askari, Camellia Shoapour