Abiotrophia defectiva Endocarditis: A Rare Cause with Aggressive Systemic Embolisation and Need of Valve Replacement

Infective endocarditis (IE) is a well-described infectious disease, one with increased morbidity and mortality being the third or fourth most common life-threatening infection syndrome. Abiotrophia defectiva is a non-motile, catalase negative, gram-positive coccus in a chain, which can be isolated from the oral cavity, intestinal, and genitourinary tracts. IE due to this agent is rare and associated with heart valve destruction, congestive heart failure, and high embolisation rates, these being the major mortality causes. We present a case of IE due to this agent, complicated with a stroke, and splenic and renal infarction, with the need for aortic valve replacement. This article highlights the gaps of knowledge left by the rarity of this disease, which range from its diagnosis to its treatment, and what we need to mitigate such gaps, supported with a case description of a successful treatment of this infection. LEARNING POINTS: Infective endocarditis due to Abiotrophia defectiva has usually an indolent course, but the embolisation potential is very high. The major causes of mortality with this species are congestive heart failure due to valve destruction and the presence of multiple emboli. Surgical intervention rates are high with Abiotrophia defectiva, reaching 50% of cases.