Shaik Ayesha, Roeuth David, Azmeen Ayesha, Thanikonda Varshitha, Guevara-Pineda Daniel, Alamnajam Mansour, Yamase Harold, Haider Lalarukh
Internal Medicine, UConn Health Cente, Farmington CT, United States.
Department of Nephrology, UConn Health Center, Farmington, CT, United States.
IDCases. 2020 May 11;21:e00792. doi: 10.1016/j.idcr.2020.e00792. eCollection 2020.
Granulicatella is a type of nutritionally variant Streptococcus (NVS) that requires special medium for growth. It has shown to cause infective endocarditis which is associated with higher mortality and complications. We present a case of Granulicatella causing endocarditis and glomerulonephritis. There has only been one such prior case report. An adult male with a remote history of gastric bypass presented with shortness of breath with exertion, lower extremity swelling of 1-month duration. Blood cultures 4/4 bottles grew Granulicatella albicans with infected tooth being the source. Transesophageal echocardiogram revealed a vegetation on the mitral valve. He received intravenous vancomycin. He was found to have acute kidney injury requiring hemodialysis. Kidney biopsy revealed immune complex deposits in the mesangium and along the capillary basement membrane suggestive of post infectious glomerulonephritis. It is crucial to recognize NVS as potential cause for endocarditis in cultures that are slow growing. NVS require a special medium. Though it is rare, NSV can also cause glomerulonephritis. Early recognition is important to help with determining treatment options which may include immunosuppressive therapy along with treatment of underlying infection.
颗粒链菌属是一种营养变异型链球菌（NVS），需要特殊培养基才能生长。它已被证明可引起感染性心内膜炎，这种疾病与较高的死亡率和并发症相关。我们报告一例由颗粒链菌属引起的心内膜炎和肾小球肾炎病例。此前仅有一例这样的病例报告。一名有胃旁路手术史的成年男性出现劳力性呼吸困难、下肢肿胀1个月。4瓶血培养中有4瓶培养出白色颗粒链菌，感染源为感染的牙齿。经食管超声心动图显示二尖瓣有赘生物。他接受了静脉注射万古霉素治疗。发现他患有急性肾损伤，需要进行血液透析。肾脏活检显示系膜和沿毛细血管基底膜有免疫复合物沉积，提示感染后肾小球肾炎。在生长缓慢的培养物中，将NVS识别为心内膜炎的潜在病因至关重要。NVS需要特殊培养基。虽然罕见，但NSV也可引起肾小球肾炎。早期识别对于确定治疗方案很重要，治疗方案可能包括免疫抑制治疗以及对潜在感染的治疗。
