Aerococcus Urinae: A rare cause for multi-valve endocarditis | Biomed Grid

A 42-year-old male with a history of chronic nephrolithiasis presented to the hospital after neighbors found him unconscious at home. On initial evaluation, he was febrile (38.9) with blood pressure of 120/104mmHg. He was severely hypoxic with a sinus rate of 90 beats/minute. His examination revealed multiple abrasions, and he was minimally responsive with a holosystolic murmur at the apex. His electrocardiogram showed normal sinus rhythm with no acute ST-T wave changes. Laboratory data revealed a white cell count of 17.4/nl, platelet count of 109/nl, lactate level of 4.8 mmol/l and creatinine of 1.57mg/dl. Computed tomography of the head revealed multiple regions of acute infarction involving the right inferior cerebellum, left occipital lobe with mass effect on the left occipital horn. He underwent a transthoracic echocardiogram that showed vegetations on both the mitral and aortic valve. He underwent a trans-esophageal echocardiogram, which demonstrated multiple vegetations on the mitral (Figure 1), aortic (Figure 2) and pulmonic valves (Figure 3) with severe pulmonic, mitral and aortic insufficiency (Figure 4 & 5). Despite negative urine cultures, serial blood cultures grew Aerococcus urinae and he was given appropriate IV antibiotics. He was evaluated for possible valvular surgery and was deemed to be a poor surgical candidate. He later developed splenic and renal infarcts followed by significant hemodynamic instability requiring vasopressors and ultimately succumbed to his illness after he developed multi organ failure and disseminated intravascular coagulation.