Staphylococcus lugdunensis endocarditis following lower extremity revascularization

We describe a fatal case of Staphylococcus lugdunensis aortic valve endocarditis that was diagnosed in a 75-year-old man approximately 6 months following a lower extremity by-pass surgery. A relatively indolent clinical course in the early phase following the suspicious exposure may have contributed to a delay in the diagnosis. At the time of presentation the patient had evidence of rapidly progressive congestive heart failure with anasarca, dyspnea and low grade fevers. Blood cultures were positive for coagulase-negative staphylococci and a transthoracic echocardiogram was not clearly suggestive of infective endocarditis. Despite intense medical treatment the patient expired on day four of hospitalization. On post-mortem examination, multiple vegetations were observed on the aortic valve and culture identification showed S. lugdunensis. Early detection of coagulase-negative bacteremia from multiple blood culture samples in this clinical setting is critical and should give rise to a suspicion of this rare but often fatal form of infective endocarditis. Besides appropriate antibiotic treatment, early surgical referral for valve replacement should be considered since it appears to be the only treatment positively affecting survival. Finally, further studies are needed to establish the efficacy of antibiotic prophylaxis in patients undergoing angiograms with a femoral approach.