[Bacillus cereus endocarditis and a probable cutaneous gateway].
BACKGROUND
Bacillus cereus is a ubiquitous telluric organism. B. cereus endocarditis is a rare condition seen mostly in prosthetic heart valves and among intravenous drug users. We report a new case of a patient without risk factors and with a good clinical outcome not requiring valve replacement.


METHODS
In October 2014, a 50-year-old woman was referred to the dermatology department of Lille University Hospital for lower-limb wounds developing 6 months earlier. She presented fever without clinical signs of infection, except for the lower-limbs wounds. Blood cultures revealed the presence of B. cereus. Transesophageal echocardiography was performed and revealed two foci of aortic valve vegetation with a diameter of 5mm. After bacterial sensitivity testing, rifampicin and levofloxacin treatment was given for six weeks, with complete remission. A skin graft was performed and good improvement was seen.


CONCLUSIONS
Nineteen cases of B. cereus endocarditis have been described previously, only one of which was without risk factors. We described a case of complete remission after a 6-week course of antibiotics. Our case demonstrates that BC should not be considered as a blood culture contamination, and that treatment may be complex due to antibiotic resistance.
Service de médecine interne, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France. Electronic address: simon.soudet@gmail.com.
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Soudet
Service de dermatologie, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France; Faculté de médecine, université de Lille 2, 59045 Lille cedex, France.
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Becquart
Service de dermatologie, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France.
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Dezoteux
Faculté de médecine, université de Lille 2, 59045 Lille cedex, France; Service de maladies infectieuses, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France.
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Faure
Service de dermatologie, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France; Faculté de médecine, université de Lille 2, 59045 Lille cedex, France.
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Staumont-Salle
Service de dermatologie, hôpital Claude-Huriez, CHRU, 59037 Lille cedex, France; Faculté de médecine, université de Lille 2, 59045 Lille cedex, France.
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Delaporte
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001409:Bacillus cereus / Q000302:isolation & purification*; D004359:Drug Therapy, Combination; D004696:Endocarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D064704:Levofloxacin / Q000627:therapeutic use*; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D012293:Rifampin
Antibiothérapie; Antibiotics; Bacillus cereus; Endocardite; Endocarditis; Ulcères; Wounds