Staphylococcus lugdunensis pulmonary valve endocarditis in a patient on chronic hemodialysis.
We describe a case of Staphylococcus lugdunensis pulmonary valve endocarditis in a 65-year-old woman on chronic hemodialysis and provide a review of previously reported cases. The patient presented with fever and altered mental status, but had no other localizing symptoms or signs; coagulase-negative staphylococcus (subsequently identified as S. lugdunensis) was isolated from two sets of blood cultures. Transthoracic and transesophageal echocardiograms showed a large (2.3 x 3.1 cm) vegetation on the pulmonary valve with moderate valvular insufficiency. The patient was treated with 6 weeks of antibiotic therapy and is stable 4 months following the completion of therapy; no surgical intervention was performed. Of the 28 previously reported cases of S. lugdunensis endocarditis, only 1 had previously survived with medical therapy alone. This is the 3rd case report of S. lugdunensis endocarditis in a patient on hemodialysis; the presumed portal of entry in this and previously reported cases was the vascular access device. Endocarditis due to this organism is characterized by a high mortality, rapid tissue destruction, and a predilection for native valves. Because the clinical outcome is much more favorable with valvular replacement, speciation of the organism assumes great importance in defining the therapeutic approach.
Kamaraju
S
S
Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Nelson
K
K
Williams
D N
DN
Ayenew
W
W
Modi
K S
KS
D000368:Aged; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011664:Pulmonary Valve / Q000382:microbiology / Q000473:pathology*; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D013210:Staphylococcus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents