Lactobacillus rhamnosus endocarditis associated with dental procedure in a patient with Marfan’s variant and prior aortic root replacement

A man in his 60s with a medical history of Marfan’s variant with remote valve sparing aortic root replacement presented for evaluation of subacute fevers, chills and night sweats. He had no significant preceding history other than a dental cleaning performed with antibiotic prophylaxis. Blood cultures grew Lactobacillus rhamnosus which was susceptible to penicillin and linezolid but resistant to meropenem and vancomycin. A transthoracic echocardiogram showed an aortic leaflet vegetation with chronic moderate aortic regurgitation but no reduction in his ejection fraction. He was discharged home and treated with gentamicin and penicillin G, initially with adequate response. However, he was subsequently readmitted for persistent fevers, chills, weight loss and dizziness, found to have multiple acute strokes secondary to septic thromboemboli. He underwent definitive aortic valve replacement with excised tissue confirming infective endocarditis.