PT  - JOURNAL ARTICLE
AU  - Saira Farid
AU  - Zerelda Esquer Garrigos
AU  - M Rizwan Sohail
TI  - Infective endocarditis due to <em>Granulicatella elegans</em> presenting with musculoskeletal symptoms
AID  - 10.1136/bcr-2019-229294
DP  - 2019 Aug 01
TA  - BMJ Case Reports
PG  - e229294
VI  - 12
IP  - 8
4099  - http://casereports.bmj.com/content/12/8/e229294.short
4100  - http://casereports.bmj.com/content/12/8/e229294.full
SO  - BMJ Case Reports2019 Aug 01; 12
AB  - A 62-year-old man with essential hypertension and right L4-L5 hemilaminectomy was referred to rheumatology for evaluation of severe arthralgia and myalgia for 12 months. Review of symptoms was significant for night sweats and 20 pounds unintentional weight loss. Physical examination was significant for holosystolic murmur best heard at the cardiac apex of unclear chronicity. Laboratory investigations revealed elevated inflammatory markers, white blood cell count and B-type natriuretic peptide. Transoesophageal echocardiogram showed flail posterior mitral leaflet with severe mitral regurgitation and two vegetations (2.5×1 cm and 1.6×0.3 cm). Abdominal CT showed new focal splenic infarcts, and a brain MRI revealed subacute infarcts, consistent with the embolic phenomenon. Blood cultures grew Granulicatella elegans. The patient underwent mitral valve replacement surgery followed by 6 weeks of parenteral therapy with vancomycin and gentamicin, with full recovery at a 3-month follow-up.