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Case Reports: Rare disease
An Unusual cause of Endocarditis
  1. Rhys Watkins1,
  2. Carl Marincowitz2,
  3. Thomas Locke3,4 and
  4. Steven Hunter5
  1. 1Northern General Hospital Emergency Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
  3. 3Department of Medical Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  4. 4Department of Infection, Immunity and Cardiovascular Disease and the Florey Institute for Host-Pathogen Interactions, The University of Sheffield, Sheffield, UK
  5. 5Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Rhys Watkins; rhys.watkins2{at}nhs.net

Abstract

A man in his 20s attended the emergency department with three days of fever, headache, reduced appetite and a sore throat. COVID-19 point-of-care test was negative. Blood cultures grew a gram-negative coccobacillus, Neisseria elongata. Following an episode of confusion, MRI head revealed septic emboli. Prolapse of the mitral valve with regurgitation was noted on echocardiography. Infection was found to have originated from multiple dental caries and treatment required a combination of dental extraction, prolonged antibiotic therapy and surgery for mitral valve repair.

N. elongata is part of the normal oropharyngeal flora but is also a rare cause of endocarditis. There are no established treatment guidelines for endocarditis of this aetiology. N. elongata endocarditis may present atypically, with a murmur only developing several days later. ‘Classical’ stigmata should not be relied on to make a diagnosis. N. elongata predominantly affects the left side of the heart and predisposes to embolic events.

  • Cardiovascular medicine
  • Valvar diseases
  • Emergency medicine
  • Cardiothoracic surgery
  • Infectious diseases

https://doi.org/10.1136/bcr-2022-249214

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    Footnotes

    • Contributors The idea for the case report was conceived by RW, who was also responsible for writing and submitting the article. CM, TL and SH read, commented on and approved the final manuscript and provided information on the patient that contributed to the case report. SH offered invaluable information regarding the operation and provided the intraoperative TOE image. MRI and OPG images supplied by Dr Saminderjit Kular (Neuroradiology Fellow, Sheffield Teaching Hospitals). Images of cultures and microscopy provided by Dr Gayti Morris (Microbiology Consultant, Sheffield Teaching Hospitals). Patient supplied own testimonial.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.