Dolosigranulum Pigrum Bacteremia in an Injecting Drug User Associated with Methicillin Resistant Staphylococcus Aureus Endocarditis and Fungal Endophthalmitis

Abstract

Dolosigranulum pigrum is a commensal bacterium of the upper respiratory tract. We present a case of D. Pigrum bacteremia, identified incidentally in a patient with a history of injecting drug use (IDU), chronic hepatitis C (HCV) and partially treated methicillin resistant staphylococcus aureus (MRSA) endocarditis, who presented with acute monocular vision loss. Workup was consistent with unilateral fungal endophthalmitis. The patient was initially treated with intravenous Voriconazole, Ceftriaxone and linezolid for 4 weeks with resolution of his symptoms. This case highlights the emerging role of D. Pigrum as a pathogen in the immune compromised and specifically in the IDU population. This case further illustrates that although identification of fungal growth in vitreous fluid may include culture and PCR analysis, fungal endophthalmitis remains a clinical diagnosis and that fungal cultures have lower sensitivity.