Introduction
Abiotrophia defectiva is a nutritionally deficient streptococci species that has significant potential for endovascular damage, and is implicated in many cases of culture-negative endocarditis [1]. Due to its fastidious nature, diagnosis and treatment can typically be delayed, which leads to suboptimal outcomes. A. defectiva has been implicated in distal embolization to organs, leading to multiorgan failure [2]. We present the rare case of A. defectiva endocarditis, leading to simultaneous anterior choroidal artery infarction with spinal osteomyelitis and discitis.
Case Presentation
We present the case of a 67-year-old male with past medical history of mitral valve prolapse, aortic stenosis treated with aortic valve replacement (AVR), coronary artery disease treated with coronary artery bypass graft (CABG) and essential hypertension who presented to the hospital with a 2-day course of dizziness and frequent falls. He reported multiple falls over the course of three months that had worsened recently. In addition, he reports incidental right-sided hearing loss, as well as nights sweats, anorexia, and a 26-lb weight loss during this 3-month period. He denied any head trauma, focal weakness or bowel/bladder incontinence. No evidence of infective endocarditis was found on physical examination, such as Janeway lesions or finger clubbing.
Vital signs were stable on admission. Laboratory studies were positive for elevated leukocytes at 13.6 white blood cells (WBCs), and hyponatremia at 126 mEq/L. CT imaging of the head demonstrated chronic microvascular disease with no acute intracranial abnormalities. Initial blood cultures were positive for Gram positive cocci in chains; empiric vancomycin was started. MRI brain demonstrated a subacute infarct in the medial aspect of the left temporal lobe, likely in the anterior choroidal artery (Figure 1).