A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia

Abstract

A 57-year-old man presented with abdominal pain, hematemesis, and melena. He reported taking high-dose ibuprofen for back pain and drinking several 24-ounce beers daily. Examination was remarkable for icteric sclera, poor dentition, tachycardia, and crescendo-decrescendo murmur at right upper sternal border, radiating to the carotids. Labs revealed leukocytosis, anemia, thrombocytopenia, and elevated liver function tests and INR. Endoscopy demonstrated antral ulcers, duodenitis, and esophagitis. Blood cultures were obtained and broad-spectrum antibiotics started; cultures later grew Streptococcus mitis, and antibiotic coverage was narrowed. Transthoracic echocardiogram (TTE) demonstrated aortic stenosis and regurgitation, but no vegetation. Repeat blood cultures were negative; however, the patient developed neurological symptoms concerning for cauda equina syndrome, and MRI revealed epidural abscess. Emergent decompression could not be performed as the patient developed hematemesis and required intubation. Transesophageal echocardiogram (TEE), initially deferred due to friable esophageal mucosa, was performed and revealed small aortic valve vegetation. Poor oral hygiene was felt to be the probable source of the patient's S. mitis bacteremia, epidural abscess, and infective endocarditis. The patient's neurological symptoms resolved without intervention and remaining teeth were extracted. This case demonstrates that Streptococcus mitis can result in clinically significant bacteremia, particularly in immunocompromised patients, including chronic heavy alcohol users.

Epidural abscess related toStreptococcus mitisin a 57-year-old immunocompetent patient

“…Byrd and Nemeth described the case of a 57-year-old man with poor dentition and chronic alcohol abuse who presented a cauda equina syndrome related to an epidural abscess and a septic endocarditis with bacteraemia related to S. mitis. 21 All patients showed recovery after drainage and antibiotics like our patient.…”

The c‐di‐AMP signaling system influences stress tolerance and biofilm formation of Streptococcus mitis

“…Immunocompromised individuals such as neutropenic cancer patients are especially vulnerable to bacteremia caused by S. mitis (Basaranoglu et al, 2019 ; Marron et al, 2000 ; Shelburne et al, 2014 ). In addition, local infections where S. mitis has been identified as the disease‐causing agent have been reported sporadically (Al‐Farsi et al, 2018 ; Byrd & Nemeth, 2017 ; Lu et al, 2003 ; Nygren et al, 2018 ). Persistent colonization of the oral cavity requires that bacteria can adhere to epithelial cells, form biofilm on the teeth, and avoid inducing a strong host immune response.…”

A Case of Urinary Tract Infection Caused by Multidrug Resistant Streptococcus mitis/oralis

“…Infections caused by S. mitis/oralis were primarily associated with infective endocarditis, 3,4 but recent case reports have documented sepsis, liver abscesses, and endophthalmitis caused by this bacterium. [5][6][7] Common urinary tract infection (UTI) pathogens include Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Staphylococcus saprophyticus, and some of them demonstrate multidrug resistance.…”