Diagnostic Challanges: Granulicatella Adiacens Endocarditis in a Asplenic Patient With a Bioprosthetic Aortic Valve

Introduction Infective endocarditis (IE) remains a challenging condition in modern medicine, especially in patients with a history of valve replacement and multiple comorbidities. This case report highlights the complexities of diagnosing and managing IE in the context of extensive cardiovascular and systemic disease. Case Presentation A 60-year-old asplenic male with a biological aortic valve prosthesis was hospitalized for severe back pain, initially suspected to be related to intervertebral disc pathology. He has experienced intermittent fever since the spring of 2024. In September, the patient experienced an ischemic stroke with left-sided hemiparesis. Elevated inflammatory markers and pulmonary infiltration with positive Mycoplasma pneumoniae IgG led to a diagnosis of atypical pneumonia treated with macrolides, partially improving symptoms but delaying the recognition of underlying conditions. Shortly thereafter, the patient developed acute femoral artery thrombosis, requiring surgical thrombectomy. A prolonged diagnostic journey, with initial misattribution of symptoms, delayed the recognition of IE. Blood cultures eventually identified Granulicatella adiacens. Transoesophageal echocardiography (TOE) revealed a small, low-echoic mass on the leaflet of the biological aortic valve prosthesis. Despite targeted antibiotic therapy, the patient’s condition progressively worsened and ultimately, he succumbed to multi-organ dysfunction syndrome (MODS), highlighting the diagnostic challenges and severe complications of IE. Discussion The gram-positive coccus Granulicatella adiacens accounts for 5 – 6% of infective endocarditis cases [1]. This pathogen forms biofilms that allow persistent infection and immune evasion [2]. Symptoms included fever, embolic events, and systemic complications [3]. Diagnosis requires specific culture methods or molecular tests owing to its fastidious nature. Treatment involved penicillin or ceftriaxone with gentamicin. Prognosis worsens with delayed diagnosis [4]. Conclusions This case highlights the importance of early recognition, microbiological identification, and tailored antimicrobial therapy in improving IE outcomes. Given its nonspecific presentation, clinicians should maintain a high index of suspicion, particularly in high-risk patients with prolonged fever and embolic events. Thorough history-taking, early use of TOE, and advanced microbiological techniques can aid in timely diagnosis and better patient outcomes.