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Challenges in the diagnosis and management of Granulicatella elegans endocarditis in a 9-year-old child
  1. Victoria Holloway1,
  2. George Jacob2 and
  3. Nicholas Hayes3
  1. 1Paediatrics, Royal Berkshire Hospital, Reading, UK
  2. 2Microbiology, Royal Berkshire Hospital, Reading, UK
  3. 3Paediatric Cardiology, Southampton University Hospitals NHS Trust, Southampton, UK
  1. Correspondence to Dr Victoria Holloway; vjholloway{at}


A 9-year-old child, with a background of repaired pulmonary atresia and Ebstein’s anomaly, presented with fever, night sweats and lethargy. Blood cultures grew Granulicatella elegans, a nutritionally variant Streptococcus and known cause of infective endocarditis (IE). Echocardiogram revealed no clear vegetation, but increased stenosis of the right ventricle to pulmonary artery conduit. The child was successfully managed with high-dose benzylpenicillin, completing 2 weeks in the hospital, and was discharged to complete the final 4 weeks of therapy with ceftriaxone in the community, as per European Society of Cardiology guidance. IE caused by any Granulicatella species is rare, with infection due to G. elegans rarer still. It is a Gram-positive bacteria that presents a diagnostic challenge due to non-specific symptoms at presentation and difficulty in growing the organism on culture medium. We present a case of G. elegans endocarditis in a young child, which illustrates the challenges in managing this condition and the importance of considering atypical organism endocarditis in children presenting with fever of unknown origin, in particular those with a background of congenital cardiac disease. We review the literature on Granulicatella endocarditis, and briefly discuss the challenges of managing this condition in a child with an autism spectrum disorder and learning difficulties.

  • drugs: infectious diseases
  • paediatrics
  • congenital disorders
  • infectious diseases

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  • Contributors All persons who meet authorship criteria are listed as authors. GJ and VJH identified the patient and this case’s potential for an educational and interesting publication. VJH performed a literature review and drafted the case report, with specialist contributions from GJ and NH. All authors reviewed the final manuscript.

  • 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 Parental/guardian consent obtained.

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