Bacteremia due to Actinomyces neuii has been reported in the literature 14 times. A. neuii is an endogenous organism that has been cultured in clinical specimens of the genitourinary tract; we are reporting a unique case of A. neuii postoperative testicular abscess with bacteremia which was successfully treated with surgery and a short course of parenteral antimicrobials.

Highlights Bactrim failure adverse effects. Alternative echinocandin target. Combination echinocandin therapy.

Vaccination with the inactivated influenza vaccine is routinely recommended for all patients before and after transplant, with reduction in complications noted in transplant recipients. The vaccine is relatively well tolerated with few mild side effects. Cytomegalovirus (CMV) infection can reactivate in both solid organ transplant and hematopoietic stem cell transplant recipients, with some patients progressing to disease. There are multiple factors known to contribute to reactivation and subsequent CMV disease, however vaccination has not been reported as a specific risk factor. We report on two renal transplant recipients who were seen to develop CMV viremia and CMV disease after receiving the Influenza vaccine. We review the literature regarding viremia occurring after vaccination in HIV patients (a similar group of immunocompromised patients).

Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci and can be found ubiquitously in normal human flora. SAG is known to form invasive pyogenic infection when it becomes pathogenic. Yet, SAG is a very rare cause of endocarditis, and there is a dearth of case reports on this topic. We present a rare case of native bicuspid aortic valve endocarditis secondary to S. anginosus that caused aortic insufficiency and ascending aortic aneurysm. To our knowledge, this is the first well-documented case report of community-acquired S. anginosus endocarditis on a bicuspid aortic valve in an immunocompetent patient. The patient first presented with cough that was likely due to bronchus irritation from a 5.5 x 5.2 cm ascending aortic aneurysm. He underwent aortic valve replacement with bovine bioprosthesis and ascending aortic aneurysm repairment and was treated with a two-week regimen of IV ceftriaxone and gentamicin followed by another four weeks of IV ceftriaxone. He was eventually discharged to a rehabilitation facility. SAG is usually susceptible to beta-lactam antibiotics. The prognosis of SAG infection is usually good, but progression to bacteremia carries a poor outcome.