Lactobacillus Endocarditis-Associated Glomerulonephritis Complicated by anti-Coagulant Nephropathy and Renal Amyloidosis

Abstract

Kidney injury is a well-known sequelae of infectious endocarditis. Various types of kidney injury can be seen, including endocarditis-associated glomerulonephritis, and may affect nearly half of the patients with infectious endocarditis. Lactobacillus species are an infrequently documented cause of endocarditis. We present a case of Lactobacillus endocarditis-associated glomerulonephritis in a patient with a complex medical history including Lactobacillus infection of an artificial heart valve. To our knowledge, this is the first reported case of development of endocarditis-associated glomerulonephritis secondary to Lactobacillus species organisms. Furthermore, the patient’s renal biopsy revealed several frequently overlooked concomitant findings including anti-coagulant nephropathy and renal amyloidosis.

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…Complications observed in cases of endocarditis comprised: Multilevel discitis [ 18 , 29 ]; Occlusion of the superior mesenteric artery for a thrombus, requiring urgent surgical laparotomy, associated to emboli in the brain cortex [ 34 ]; Splenic infarct, possibly caused by septic emboli [ 18 , 20 , 23 ]; Multiple embolic strokes with acute-to-subacute infarct in the brain parietal lobe and a rapidly progressive glomerulonephritis (RPGN) [ 24 ]; Splenic abscess [ 20 ]; Glomerulonephritis and thrombotic microangiopathy [ 19 ]; Microabscesses in the psoas [ 29 ]; Embolic stroke and presumed lumbar vertebral osteomyelitis [ 33 ]; Recurrent transient ischemic attacks possibly related to a central embolic source causing left side lower extremity weakness and expressive aphasia [ 15 ]; Peroneal mycotic pseudoaneurysm supposed to be caused by seeding of blood-borne bacteria to the vasa vasorum of the artery wall or septic emboli from the infected heart valve [ 35 ]; Acute respiratory failure and septic shock [ 17 ]; Infarction secondary to septic embolism and ruptured mycotic brain aneurysm suspected to be caused by septic embolism from the aortic valve vegetation with right-sided hemiplegia and aphasia [ 14 ]; Ankle arthritis with cutaneous eruption [ 22 ]. …”