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Abstract Details

Lactococcus garvieae endocarditis with an initial presentation of subarachnoid hemorrhage
Neuro Trauma, Critical Care, and Sports Neurology
P5 - Poster Session 5 (5:30 PM-6:30 PM)
4-048
NA

Lactococcus garvieae is an unusual pathogen of infective endocarditis (IE). We describe a patient with

subarachnoid hemorrhage (SAH) who was found to have a mycotic aneurysm leading to a diagnosis of

Lactococcus garvieae endocarditis. SAH as the initial presentation of lactococus species endocarditis is

an unheard phenomenon and our patient is the first reported case in literature.
The patient is a 68 year old man with a history of severe aortic stenosis and a prosthetic biological valve. He presented with altered mental status and found to have SAH on computed tomography (CT). MRI revealed prominent acute SAH in the right central sulcus and right occipital lobe, sub-acute SAH in the left superior temporal sulcus. MR angiogram showed no evidence of vasculitis and a CT angiogram
revealed SAH with two focal aneurysms in the central sulcus concerning for mycotic aneurysms. Blood
cultures yielded lactococcus garvieae and the patient was started on ceftriaxone and gentamicin for six weeks. A trans-esophageal echocardiogram revealed multiple nodules on the valve with aortic root
thickening concerning for prosthetic valve endocarditis. His hospital course was complicated by
worsening heart failure. He was eventually transitioned to comfort measures as there was high risk of
mortality associated with surgical intervention.
Despite its low virulence, IE is the most common manifestation of lactococcus infection. Although,
transmitted by consumption of raw fish, patients with gastrointestinal modifications and valve
replacements have been predominantly identified. SAH occurs as a complication of IE in around 1% of
cases and the pathogenesis is thought to involve rupture of a mycotic aneurysm.
We describe the first case in literature with subarachnoid hemorrhage as the only presenting sign of infective lactococcus garvieae endocarditis.
Authors/Disclosures
Abinayaa Purushothaman Ravichandran, MBBS
PRESENTER 		Dr. Purushothaman Ravichandran has nothing to disclose.
Nathan P. Fenstermacher (Lehigh Valley Health Network) Mr. Fenstermacher has nothing to disclose.
Shweta Varade, MD (Lakeridge Health) Dr. Varade has nothing to disclose.
Preet M. Varade, MD (Lehigh Valley Hospital - Cedar Crest) Dr. Varade has nothing to disclose.