Jennifer A Creed, Divyang Patel and Larry B Goldstein
Aerococcus urinae is a Gram-positive, catalase-negative coccus that was first defined in 1992. A. urinae is responsible for up to 0.8% of all cases of urinary tract infection. Typical predisposing factors include male sex, age >65 years and pre-existing urinary pathology. A. urinae is a rare cause of endocarditis but has a high associated morbidity and mortality. Sepsis or septic shock is the primary clinical presentation but there have been several reports of cerebral ischemic events in the setting of A. urinae endocarditis. These case descriptions are very limited and do not include brain imaging. We describe the clinical course of a 75 year-old man who, in the setting of A. urinae mitral valve endocarditis, presented with symptoms and imaging findings consistent with embolic cerebral infarction. Importantly, mitral valve vegetation was detected only after transesophageal echocardiography. Given the risk of morbidity without treatment, these data support pursuing a transesophageal approach even when transthoracic echo is negative.
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