TY - JOUR T1 - Infective endocarditis due to <em>Granulicatella elegans</em> presenting with musculoskeletal symptoms JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-229294 VL - 12 IS - 8 SP - e229294 AU - Saira Farid AU - Zerelda Esquer Garrigos AU - M Rizwan Sohail Y1 - 2019/08/01 UR - http://casereports.bmj.com/content/12/8/e229294.abstract N2 - 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. ER -