Infective Endocarditis Secondary to Granulicatella adiacens

Diagnostic testing Initial abdominal radiography scans showed diffuse bowel ileus vs distal large bowel obstruction. A computed tomography scan of the abdomen and pelvis showed a mildly distended, fluid-filled stomach and small bowel, suggestive of enterocolitis (Figure). Laboratory study findings were significant for an elevated white blood cell count of 14.67 × 109/L. Initial blood cultures resulted in growth of gram-positive cocci in pairs and chains, but no growth was seen in the urine culture. The patient was initially started on ceftriaxone and vancomycin. Three days after hospital admission, blood cultures grew Granulicatella adiacens, and the patient underwent an echocardiography scan, results of which revealed bacterial endocarditis on the aortic valve. The patient was educated on the need for outpatient colonoscopy and dental follow-up and was discharged on 4 weeks of intravenous ceftriaxone outpatient parenteral antibiotic therapy.