eWe describe the first reported case of endocarditis due to Neisseria skkuensis. The organism from the blood cultures taken on admission day was identified initially as unidentified Gram-negative cocci by Vitek2. Finally, it was identified as Neisseria skkuensis by 16 rRNA gene sequence analysis.
CASE REPORTA 41-year-old man was admitted to our hospital with a 1-week history of febrile sense, chills, sweating, aggravation of dyspnea, and hypotension during hemodialysis. He had a complicated history, including liver cirrhosis caused by chronic hepatitis B infection and chronic kidney disease due to glomerulonephritis. He had received entecavir since 2009 and hemodialysis since 2000. In addition to these, he had undergone a mechanical mitral valve replacement due to infective endocarditis caused by methicillinresistant Staphylococcus aureus more than 1 year ago. He denied having had dental treatment or drug abuse since mitral valve replacement.On arrival at the emergency department, the patient's vital signs were as follows: blood pressure, 86/52 mm Hg; respiratory rate, 22 breaths per min; and temperature, 37°C. Physical examination revealed metallic heart sounds without murmur and no abdominal tenderness with positive shifting dullness. A chest radiography showed cardiomegaly and pulmonary edema. Laboratory investigations revealed a C-reactive protein concentration of 10.0 mg/dl (normal [N], Ͻ0.3 mg/dl), an erythrocyte sedimentation rate of 37 mm/h (N, Ͻ22 mm/h), and a procalcitonin concentration of 152.2 ng/ml. The white blood cell (WBC) count was 9,850/mm 3 with dominant segmented neutrophils (85%), hemoglobin (Hb) at 7.5 g/dl, platelet count of 57,000/mm 3 , blood urea nitrogen at 49.5 mg/dl, creatinine at 6.55 mg/dl (N, Ͻ1.3 mg/dl), and total bilirubin at 1.2 mg/dl (N, Ͻ1.5 mg/dl). He was coagulopathic with a prothrombin time of 23