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).