Granulicatella elegans Infective Endocarditis in a Pediatric Patient

Granulicatella elegans (G. elegans) is a fastidious, nutritionally variant streptococcus (NVS) that represents a rare but clinically significant cause of infective endocarditis (IE), particularly in patients with congenital heart disease (CHD). Diagnosis is frequently delayed owing to its specific culture requirements and an indolent, non-specific clinical presentation. We present a case of a six-year-old male with complex CHD who presented with an 11-day history of low-grade fever, anorexia, and asthenia. Seven months prior, he had undergone dental caries repair without antibiotic prophylaxis. Transthoracic echocardiography (TTE) showed no vegetations. After 18 days of incubation in enriched culture media, blood cultures yielded the identification of G. elegans. A diagnosis of possible IE was established per the modified Duke criteria. Treatment with ceftriaxone and gentamicin was initiated per the European Society of Cardiology (ESC) 2023 guidelines, subsequently switched to vancomycin due to hematological toxicity. The patient was discharged in stable condition and remained asymptomatic at a three-year follow-up. Comparison with five previously published pediatric cases of Granulicatella IE was made. G. elegans IE should be considered in any child with CHD and prolonged unexplained fever, even in the absence of classical echocardiographic findings.