title: Granulicatella adiacens subacute bacterial endocarditis as the underlying cause of type II mixed cryoglobulinaemia.
abstract: A 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing-remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yielded Granulicatella adiacens which was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grew G. adiacens. The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia.
authors.affiliation: Infectious Diseases Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
authors.forename: Benjamin W C
authors.initials: BW
authors.lastname: Sim
authors.affiliation: Infectious Diseases Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
authors.forename: Ray Mun
authors.initials: RM
authors.lastname: Koo
authors.affiliation: Department of Immunology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia Australian National University (ANU) Medical School, Canberra, Australian Capital Territory, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hawkins
authors.affiliation: Infectious Diseases Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia Australian National University (ANU) Medical School, Canberra, Australian Capital Territory, Australia.
authors.forename: Francis
authors.initials: F
authors.lastname: Bowden
authors.affiliation: Infectious Diseases Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia Australian National University (ANU) Medical School, Canberra, Australian Capital Territory, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Watson
mesh_terms: D056568:Carnobacteriaceae; D003449:Cryoglobulinemia / Q000382:microbiology*; D004698:Endocarditis, Subacute Bacterial / Q000382:microbiology* / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged