PT  - JOURNAL ARTICLE
AU  - Karime, Christian
AU  - Barrios, Maria S
AU  - Wiest, Nathaniel E
AU  - Stancampiano, Fernando
TI  - <em>Lactobacillus rhamnosus</em> sepsis, endocarditis and septic emboli in a patient with ulcerative colitis taking probiotics
AID  - 10.1136/bcr-2022-249020
DP  - 2022 Jun 01
TA  - BMJ Case Reports
PG  - e249020
VI  - 15
IP  - 6
4099  - http://casereports.bmj.com/content/15/6/e249020.short
4100  - http://casereports.bmj.com/content/15/6/e249020.full
SO  - BMJ Case Reports2022 Jun 01; 15
AB  - 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.