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Case Reports: Learning from unexpected outcome (positive or negative)
Lactobacillus rhamnosus sepsis, endocarditis and septic emboli in a patient with ulcerative colitis taking probiotics
  1. Christian Karime,
  2. Maria S Barrios,
  3. Nathaniel E Wiest and
  4. Fernando Stancampiano
  1. Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
  1. Correspondence to Dr Christian Karime; chriskarime{at}hotmail.com

Abstract

A man in his 60s presented to the emergency room with fever and fatigue after a 2.5-month course of corticosteroids. His medical history was significant for bioprosthetic aortic valve replacement and moderately severe ulcerative colitis treated with balsalazide and daily lactobacillus-containing probiotics. Initial investigations revealed Lactobacillus rhamnosus bacteraemia without complication. Four days after hospital discharge, the patient experienced acute-onset right-sided paraesthesia and lower-limb paresis. On return to the emergency room, MRI of the brain demonstrated innumerable ring-enhancing lesions with haemorrhagic transformation. Transoesophageal echocardiogram revealed a small mobile density on the bioprosthetic aortic valve, raising the suspicion for L. rhamnosus infective endocarditis with secondary septic emboli to the brain. The patient was subsequently treated with intravenous gentamycin and ampicillin, with transition to indefinite oral amoxicillin suppressive therapy. The current case highlights the potential risk of lactobacilli translocation in an immunosuppressed patient with ulcerative colitis taking probiotics.

  • Infection (gastroenterology)
  • Ulcerative colitis
  • Neuroimaging
  • Vitamins and supplements

https://doi.org/10.1136/bcr-2022-249020

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    Footnotes

    • Twitter @MedWiest

    • Contributors CK made substantial contributions to the conception or design of the work, contacted patient, summarised case, drafted the work and revised it critically for important intellectual content; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MB made substantial contributions to the conception or design of the work, drafted the work and revised it critically for important intellectual content; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NW made substantial contributions to the conception or design of the work, revised the work critically for important intellectual content and gave final approval of the version to be published. FS made substantial contributions to the conception or design of the work, revised the work critically for important intellectual content and gave final approval of the version to be published.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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