Granulicatella adiacenssubacute bacterial endocarditis as the underlying cause of type II mixed cryoglobulinaemia

Abstract

SUMMARYA 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing-remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yielded Granulicatella adiacens which was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grew G. adiacens. The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia. BACKGROUND

Cryoglobulinemic vasculitis triggered by Staphylococcus aureus endocarditis with chronic hepatitis C virus co-infection: a case report and literature review

“…Identifying CV underlying etiology is essential to select the appropriate treatment and avoid an increase in recurrence, morbidity or mortality. Misdiagnosed IE-related cryoglobulinemia treated with single immunosuppressive therapy led to relapsing ( 21 , 27 , 30 ). For many cases in our review ( Supplementary Table 1 ), including our patient, when bacterial infection was the underlying cause, anti-infective treatment alone was sufficient to result in complete clinical remission ( 32 ).…”

Granulicatella adiacens as an Unusual Cause of Empyema: A Case Report and Review of Literature

“…Using the inclusion and exclusion criteria, 24 literature were found relevant and included in the review. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Clinical details of all published literature are compiled in the Table 1 . As per the review of literature of last 10 years, G. adiacens is found to be the cause of various infections such as bacteremia, endocarditis, osteomyelitis, septic arthritis, discitis, prosthetic joint infections, carbuncle, bacterascites (spontaneous bacterial peritonitis), dacryocystitis, and abscess.…”

Infective Endocarditis Observed With Cryoglobulinemic Vasculitis

“…Despite not being commonly observed in this setting, cryoglobulinemic vasculitis has been documented as the presenting symptom of IE [ 6 - 7 ]. In a case published in 2017, a patient presented with a non-blanching purpuric rash on her lower extremities, anemia, and blood and trace protein on urine dipstick [ 8 ].…”