AN OMINOUS PRESENTATION OF STAPHYLOCOCCUS HOMINIS
H Mir MD 1 , L Dartez BS 2 , T Roussel MD 1 , D Mickey MD 1 , C Giffin MD 1 1 Department of Medicine, LSU Health Sciences Center, Baton Rouge, LA 2 School of Medicine, LSU Health Sciences Center, New Orleans, LA
INTRODUCTION This case describes acute aortic valve insufficiency caused by infectious endocarditis secondary to an unlikely pathogen in a patient who’s only known risk factor was a spinal epidural injection. Coagulase-negative staphylococci cause less than 5% of native valve infectious endocarditis (NVE) cases. The majority of those infections are due to Staphylococcus epidermidis, making Staphylococcus Hominis NVE exceedingly rare. CASE: A 79-year-old woman with chronic obstructive lung disease, tobacco abuse, acid reflux, hyperlipidemia, osteoporosis, lumbar radiculopathy, anxiety/depression, and Schatzki’s ring presented for several months of progressive dyspnea, orthopnea, nonproductive cough, and weight loss. She associated her symptom onset with a transforaminal epidural steroid injection four months prior for chronic lower back pain with radiculopathy. She had experienced chest pain, anorexia, chills, and night sweats. Vitals were notable for a widened pulse pressure (BP 119/31mmHg), tachycardia (107 bpm), and afebrile. On exam, she had a diastolic decrescendo murmur at the left 3rd intercostal space and bounding symmetrical radial pulses. These signs and symptoms led to suspicion for aortic valve insufficiency. A transthoracic echocardiogram demonstrated severe aortic valve regurgitation and moderate mitral valve regurgitation. Subsequently, blood cultures revealed growth in three of four bottles for coagulase negative staphylococci and transesophageal echocardiogram demonstrated a 0.5-1cm vegetation of the native aortic valve. Cultures speciated as Staphylococcus hominis, a common noninvasive bacteria of normal skin flora. She denied any prior abrasions, skin lesions, or IV drug use that could have introduced Staphylococcus hominis besides the steroid injection. She underwent urgent aortic and mitral valve replacement surgery and received six additional weeks of antibiotic therapy. DISCUSSION: This case demonstrates the importance of considering infectious causes (endocarditis) in the differential for acute aortic valve insufficiency. Despite remaining afebrile and undergoing a relatively safe, common procedure of spinal epidural steroid injection, she developed an infectious complication. A review of adverse events from 11,980 intra-articular facet joint injection procedures performed from 2007-2017 found only one incident of infective endocarditis. While rare, it’s important to recognize this possible complication as these procedures become more commonplace.
17
Made with FlippingBook Digital Publishing Software