From Valve to Spine and Spleen: Multisystem Complications of Gemella haemolysans Prosthetic‐Valve Endocarditis

Gemella haemolysans is an uncommon cause of infective endocarditis, yet infection involving a prosthetic valve may be accompanied by extensive extracardiac disease. A 79‐year‐old man with a history of transcatheter aortic valve replacement presented with fever, rigors, dyspnea, severe low back pain, and inability to walk after a fall. Two sets of blood cultures grew G. haemolysans . Echocardiography demonstrated a 0.6 × 0.6 cm vegetation at the aortic valve annulus. Lumbar magnetic resonance imaging identified discitis and vertebral osteomyelitis at L4–L5 and L5–S1, an anterior epidural abscess, and moderate‐to‐severe spinal canal stenosis. Abdominal imaging revealed a right psoas abscess and a 6.2‐cm splenic infarction. Antimicrobial therapy was narrowed to intravenous ceftriaxone according to susceptibility testing. Fever resolved and inflammatory markers declined during hospitalization; a 6‐week course was arranged at discharge without valve surgery. This case highlights the association between endocarditis and vertebral infection, the limitations of vegetation size as a measure of extracardiac disease, and the complexity of treatment decisions following transcatheter valve replacement.