Infective endocarditis occurs when there is an infection of the heart valves or associated cardiac hardware/devices. While typical organisms include Staphylococcus and Streptococcus species, there are reports of less common organisms such as Lactobacillus species as causative agents as well. Such infections can lead to complications, including renal failure from rapidly progressive glomerulonephritis. A 79‐year‐old male presented with acute heart failure exacerbation in the setting of new severe mitral regurgitation. His acute on chronic kidney disease was attributed to his heart failure exacerbation and returned to baseline after diuresis on discharge. He had recurrent exacerbations with worsening renal function requiring hemodialysis and prompting a renal biopsy that showed rapidly progressive crescentic glomerulonephritis. While infectious causes were not initially suspected, blood cultures were drawn to evaluate this as a potential cause, which persistently grew Lactobacillus casei . The infectious diseases team was consulted, and the patient was treated with renally adjusted ampicillin, with repeat blood cultures returning negative. Immunosuppressive therapy was deferred due to concern for active infection, and the patient was treated with targeted antimicrobial therapy alone. This case illustrates an atypical and rare presentation of Lactobacillus infective endocarditis with rapidly progressive glomerulonephritis, as well as the balance one must make between the use of antibiotics versus immunosuppression in such patients.
Chávez et al. (Thu,) studied this question.