Critical Care: Student/Resident Case Report Poster - Critical Care II |

Corynebacterium Are Not Just Contaminants: A Case of Corynebacterium Endocarditis of a Native Valve FREE TO VIEW

Mohamad Abdelfattah, MD; Rachyna Koya, MD; Margaret Kuhn-Basti, MD; Tshering Amdo, MD
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NYU Lutheran, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):400A. doi:10.1016/j.chest.2016.08.413
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Corynebacterium, though commonly labeled as blood culture “contaminants,” can cause serious infections such as endocarditis. Many bacteria can cause infective endocarditis, however Corynebacterium is in the group of organisms that account for only 3% of all endocarditis cases. Most patients who develop Corynebacterium endocarditis have structural heart disease or prosthetic valves; however, 0.2-0.4% of cases occur in normal heart valves. Indwelling intravascular lines have also been identified as a risk factor. We present a rare case of Corynebacterium endocarditis of a native valve that initially presented as contaminated blood cultures.

CASE PRESENTATION: A woman in her sixties, with a medical history of pacemaker for complete heart block, seizure disorder, and poorly controlled Type I Diabetes complicated by limb amputation, presented after two seizures. Seizures were attributed to underlying sepsis as imaging showed gas gangrene of her right first toe. Blood cultures drawn during admission grew Corynebacterium striatum. Blood cultures were considered contaminated, as repeat cultures had no growth after she completed her antibiotic course. Patient presented months later with shortness of breath and was admitted for acute heart failure exacerbation. Blood cultures drawn from this admission also grew Corynebacterium striatum along with a positive urine culture. Patient received antibiotics and the blood culture was again considered a contaminant. Routine echocardiogram showed moderate mitral valve regurgitation (MVR) and no documented vegetations. Patient was discharged home with oral antibiotics. Patient presented two weeks later for lethargy and was admitted for an infected foot ulcer. Blood cultures drawn on admission re-demonstrated Corynebacterium striatum. Repeat echocardiogram showed severe worsening MVR with a mobile echodensity. A trans-esophageal echocardiogram was performed, which confirmed a large echodensity, likely representing a vegetation. An infectious disease specialist confirmed the diagnosis of endocarditis and recommended continuing IV antibiotics for six weeks. However, the patient’s family opted for palliative care and patient expired.

DISCUSSION: Our case challenges Corynebacterium’s benign reputation as only a contaminant. These organisms are most worrisome in patients with chronic indwelling medical devices; as in our patient who had a pacemaker, increasing her risk of Corynebacterium endocarditis. Corynebacterium striatum, specifically, has been seen in other cases of pacemaker-related endocarditis. However, there have also been cases of Corynebacterium endocarditis affecting native valves in patients without indwelling devices.

CONCLUSIONS: Corynebacterium endocarditis has a mortality rate of 43.4%. This statistic alone should encourage the cautious labeling of Corynebacterium as “contaminants.”

Reference #1: Cohn SE. Native valve endocarditis due to Corynebacterium striatum: case report and review. Clin Infect Dis1994;19:1054-61

DISCLOSURE: The following authors have nothing to disclose: Mohamad Abdelfattah, Rachyna Koya, Margaret Kuhn-Basti, Tshering Amdo

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