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Fatal Lactobacillus endocarditis in a patient with transcatheter aortic valve replacement
  1. Saaket Agrawal1,
  2. Emily S Tuchman1,
  3. Matthew J Bruce1 and
  4. Maria E Theodorou2
  1. 1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Maria E Theodorou; maria.theodorou{at}


Lactobacillus species may translocate from the gastrointestinal tract into systemic circulation from ingested probiotics or commensal flora. Their pathogenic potential is still debated. Lactobacillus endocarditis is a rare entity with only around 120 cases reported in the literature. Here, we report the first case of fatal Lactobacillus endocarditis with involvement of a transcatheter aortic valve replacement with the following goals: to reaffirm the pathological significance of Lactobacillus spp, to demonstrate the potential limitations of the modified Duke criteria in diagnosing infective endocarditis of transcatheter aortic valve replacement, and to urge clinicians to aggressively search for and consider empiric treatment for endocarditis in patients with prosthetic valves who develop Lactobacillus bacteraemia.

  • valvar diseases
  • interventional cardiology
  • infectious diseases
  • cirrhosis
  • diet

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  • Contributors This manuscript was conceived (SA/ET/MB/MT), drafted (SA/ET/MB) and revised (SA/ET/MB/MT) by the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.