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Aortic Valve Endocarditis by a Rare Organism: Abiotrophia defectiva

Anurag Bajaj, Parul Rathor, Ankur Sethi, Vishal Sehgal and Julio A Ramos

Abiotrophia defectiva or nutritionally variant Streptococcus (NVS) is rare but important cause of infective endocarditis. We present a case of a 40 year old man with history of aortic valve replacement 14 years ago admitted for fever and chills. Blood culture grew A. defectiva in 4 out of 4 bottles. Patient became a febrile within few days after staring Ceftriaxone but subsequently had renal infarct due to septic embolization. Echocardiogram showed vegetations on aortic valve but no significant aortic regurgitation. After an 8 weeks course of Penicillin and Gentamicin was completed the patient had severe aortic regurgitation. Finally, aortic valve replacement and aortic root replacement was performed and patient did well after the surgery. Clinicians should be aware of this fastidious and aggressive organism when dealing with infective endocarditis. Complications rates are very high even on antibiotics and surgical treatment is needed in at least 50% of the cases.