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Spondylodiscitis revealing aerococcus viridans infective endocarditis: Rare case report

Hamza Choukrallah, Hanane Choukrani, Karim Mounaouir, Anas El Mokri, Ismail Benhar, Abdenasser Drighil, Keltoum Boumlik, Salwa Hafoud, Soufiane El Rhanbaz.

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Spondylodiscitis is a diagnostic and therapeutic emergency. The association of spondylodiscitis with infective endocarditis has been reported previously, but at a rarer frequency compared to other complications of infective endocarditis.
On admission, the patient was stable with signs of sepsis, with abnormalities of the neurological and cardiovascular examination. The lumbar MRI showed a signal remodelling of the D10 and D11 vertebrae, evoking an early infectious focus, without paravertebral collection or epidural signal abnormality. On the biological assessment, the infectious markers were disturbed.
In view of the spondylodiscitis and the infectious biological signs, a transthoracic echocardium was performed, visualizing two large mobile vegetations at the level of the atrial side of the mitral valve, one of 18x12 mm at the level of A2 (figure 1) and one of 14x12 mm at the level of P2 (figure 2), causing a medium mitral insufficiency, without other detectable vegetation images. The blood cultures came back positive to a multisensitive aerococcus viridans, notably to amoxicillin clavulanic acid, ceftriaxone, gentamycin, imipenem and vancomycin.
The incrimination of aerococcus viridans in infective endocarditis has been very rarely reported in the literature, especially in those associated with spondylodiscitis and in immunocompetent patients. Given the aggressive nature of A. viridans endocarditis and the often long delay in diagnosis, early recognition of symptoms, blood cultures, and echocardiography, including transesophageal echocardiography, are required to initiate appropriate treatment.

Key words: Spondylodiscitis, Aerococcus Viridans, Infective Endocarditis, Case Report

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