Abstract Introduction Streptococcus salivarius is a commensal bacterium predominantly found in the oral cavity and upper respiratory tract. Although generally regarded as non-pathogenic, it has been implicated in rare cases of bacteremia and infective endocarditis, particularly in individuals with predisposing factors such as prosthetic heart valves, congenital heart defects, or immunosuppression. Case Presentation A 57-year-old male with past medical history of hypertension, hyperlipidemia, cocaine use disorder, coronary artery disease with drug eluding stent placed to left circumflex, ischemic cardiomyopathy with heart failure with moderately reduced ejection fraction (40-45%) whom presented to the emergency department with chief complaint of headache and abdominal pain. Admission vitals within normal limits. Labs notable for neutrophilic predominant leukocytosis (13.48), and high-sensitivity troponin of 4674. EKG performed showing sinus rhythm with left atrial enlargement and left ventricular hypertrophy. Imaging revealing: three left frontal lobe and one right frontal lobe acute intraparenchymal hemorrhage with associated vasogenic edema alongside upper and mid splenic subcapsular hypoattenuation suggestive of infarct. Patient was admitted to the ICU, where neurology was consulted. He was started on Keppra and further imaging was performed including: magnetic resonance imaging (MRI) of the brain that showed multiple bilateral small infarcts within the left parietal white matter and right cerebellar hemisphere, and transthoracic echocardiogram with aortic and mitral valve echo densities with subsequent transesophageal echocardiogram revealing 2.1 x 0.3 cm aortic valve and 1.5 x 0.7cm mitral valve vegatations. Blood cultures were drawn which grew pan-susceptible streptococcus salivarius and he was started on intravenous ceftriaxone per infectious disease recommendations. Repeat blood cultures were negative, maxillofacial CT did not reveal any odontogenic infection, and CT thorax/abdomen/pelvis to rule out neoplasia was also negative. Patient was evaluated by cardiothoracic surgery for valve replacement whom recommended outpatient follow for surgical planning after completion of intravenous antibiotics due to emboli with hemorrhagic conversion. Discussion Infectious endocarditis is a critical condition that calls for prompt diagnosis and treatment. The presence of neutrophilic predominant leukocytosis, positive cardiac biomarkers and embolic infarcts on cerebral imaging raised clinical suspicion for endocarditis. The diagnosis was subsequently confirmed with the visualization of mitral and aortic valve vegetations on transesophageal echocardiogram, alongside positive blood cultures with strep salivarius. This case aims to raise awareness of S. salivarius as a potential causative agent of endocarditis and to emphasize the importance of early recognition and targeted antimicrobial therapy. This abstract is funded by: None
Monestime et al. (Fri,) studied this question.