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Infective endocarditis by a rare and fastidious agent: Abiotrophia defectiva
  1. Ana Margarida Mosca1,
  2. Fenando Mané2,
  3. Carla Marques Pires2 and
  4. Paulo Medeiros2
  1. 1Internal Medicine, Hospital de Braga, Braga, Portugal
  2. 2Cardiology, Hospital de Braga, Braga, Portugal
  1. Correspondence to Dr Ana Margarida Mosca; ana_mosca6{at}


Abiotrophia defectiva is a nutritional variant streptococcus, with affinity for endovascular structures that cannot be cultured on non-supplemented media, leading to a delay in diagnosis. This case describes a 36-year-old woman with a previously known bicuspid aortic valve that presented with asthenia, myalgias and anorexia with 2-month onset. On admission, we documented fever and a systolic murmur. Transthoracic echocardiography revealed an oscillating mass attached to the aortic valve. The patient was admitted with a possible diagnosis of infective endocarditis. Later, blood cultures were positive for A. defectiva. Due to severe aortic regurgitation and congestive heart failure, she underwent surgical aortic valve replacement. After 6 weeks of antimicrobial therapy, the patient experienced full recovery. Despite of its rarity, A. defectiva endocarditis is associated with significant morbidity with mortality and physicians must have a high level of suspicion to ensure a prompt diagnosis and provide the appropriate treatment.

  • valvar diseases
  • cardiothoracic surgery
  • heart failure
  • infections

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  • Contributors All coauthors have contributed to the genesis of this manuscript and have seen and approved the submission.

  • 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.

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