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Lactobacillus rhamnosus endocarditis associated with dental procedure in a patient with Marfan’s variant and prior aortic root replacement
  1. Michael Hovan and
  2. Ari Mandler
  1. Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  1. Correspondence to Dr Michael Hovan; mih2036{at}


A man in his 60s with a medical history of Marfan’s variant with remote valve sparing aortic root replacement presented for evaluation of subacute fevers, chills and night sweats. He had no significant preceding history other than a dental cleaning performed with antibiotic prophylaxis. Blood cultures grew Lactobacillus rhamnosus which was susceptible to penicillin and linezolid but resistant to meropenem and vancomycin. A transthoracic echocardiogram showed an aortic leaflet vegetation with chronic moderate aortic regurgitation but no reduction in his ejection fraction. He was discharged home and treated with gentamicin and penicillin G, initially with adequate response. However, he was subsequently readmitted for persistent fevers, chills, weight loss and dizziness, found to have multiple acute strokes secondary to septic thromboemboli. He underwent definitive aortic valve replacement with excised tissue confirming infective endocarditis.

  • Infectious diseases
  • Infections
  • Valvar diseases

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  • Contributors Both authors took care of the patient. They also contributed equally to the production of this manuscript including data collection, literature review and manuscript creation.

  • 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.