A case of infective endocarditis caused by <i>Streptococcus infantarius</i> that led to coronary artery embolism

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  • <i>Streptococcus infantarius</i>による感染性心内膜炎が冠動脈塞栓を引き起こした一例

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<p>We encountered a rare case of infective endocarditis complicated by coronary artery embolism. An 84-year-old male patient had chest pain and was brought to our emergency unit. He had underwent replacement of the aortic valve 4 years ago. In emergent coronary catheterization, coronary emboli were aspirated from the left anterior descending coronary artery. Since the symptoms and laboratory data were not remarkable, infective endocarditis was not suspected initially. However, results of histopathological analysis of the emboli on the 8th hospital day suggested bacterial infection. Thus, infective endocarditis as the cause of coronary emboli was suspected and detailed examinations were carried out. Blood culture showed positive results the next day, and transesophageal ultrasonography demonstrated aortic vegetation. Antibiotic therapy was started, and the clinical course was good thereafter. Infective endocarditis should be suspected in high-risk patients, such as those in the postvalvular replacement state, even when the symptoms are not specific. Gene analysis identified Streptococcus infantarius as the causative organism. Some species of the genus Streptococcus are associated with severe diseases, and thus the precise identification of species is necessary. However, it might be difficult to perform a differential diagnosis of species by conventional biochemical analysis. Therefore, it is recommended to coordinate closely with an institution capable of performing gene analysis for the differential diagnosis of species.</p>

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