A Rare Presentation of Native Aortic Valve Endocarditis Secondary to Streptococcus gordonii: A Case Report

Streptococcus gordonii is an alpha-hemolytic Gram-positive bacterium most commonly present in the oral cavity and gastrointestinal tract. Despite an increase in the incidence of infective endocarditis, S. gordonii cases reported on a native aortic valve are relatively uncommon. Reported cases have been linked to spondylodiskitis, intra-abdominal infection, and oral procedures. A 79-year-old male was admitted for acute kidney injury, diarrhea, and dehydration, and was found to have S. gordonii bacteremia with endocarditis. A 1.7 cm × 0.9 cm vegetation on the native aortic valve was revealed, and subsequent multiple septic emboli on brain magnetic resonance imaging (MRI) were discovered after an incident of acute mental status change. The patient was successfully treated with intravenous ceftriaxone and later required aortic valve replacement. A possible source of the bacteremia was a trigger point injection to the lumbar spine, which was consistent with MRI lumbar spine findings of a spinal abscess. However, other possible sources include a dental procedure, cholecystitis with concern for cholelithiasis, and colonoscopy with polypectomy, both incidences within eight weeks of the hospitalization. This case illustrates the importance of thorough history taking and consideration for an echocardiogram to rule out endocarditis if S. gordonii bacteremia is present, in addition to close monitoring and outpatient follow-up post-diagnosis. Considering an increasing number of procedures involving the oral cavity, spine, and abdominal area, we hope that this case will bring awareness to the diagnosis of S. gordonii endocarditis.