Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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pISSN 2288-0585 eISSN 2288-6850

Septic Peripheral Embolism in Left Leg from Aggregatibacter aphrophilus Endocarditis

Case report

Annals of Clinical Microbiology (Ann Clin Microbiol) 2009 June, Volume 12, Issue 2, pages 82-86.

https://doi.org/10.5145/ACM.2009.12.2.82

Septic Peripheral Embolism in Left Leg from Aggregatibacter aphrophilus Endocarditis

Ja Young Lee1, Si Hyun Kim1, Haeng Soon Jeong1, Seung Hwan Oh1, Hye Ran Kim1, Young Il Yang2,4, Yang Haeng Lee3, Jeong Nyeo Lee1,4, Jeong Hwan Shin1,4
Departments of 1Laboratory Medicine, 2Pathology, 3Thoracic Surgery, 4Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea

Abstract

Aggregatibacter aphrophilus is a facultatively anaerobic gram-negative coccobacillus or bacillus that grows with no dependence on X factor and variable requirement for V factor. The organism is normal flora in the human oral cavity and upper respiratory tract and, rarely, causes invasive infections such as bacteremia, endocarditis, brain abscess, or osteomyelitis. We report a case of septic peripheral embolism in left leg from A. aphrophilus endocarditis. A 49-year-old man with known hypertension presented with acute muscle pain in the left leg. On physical examination, a regular heartbeat with a pansystolic murmur was heard. There were decreased pulses in the left popliteal and dorsalis pedis arteries and coldness of the left foot, although sensory and motor functions were intact. Angiography revealed an embolus in a branch of the left femoral artery. He underwent emergency embolectomy, and gram-negative bacilli grew in the embolus cultures. The same microorganism was isolated in two pairs of blood culturs and subsequently identified as A. aphrophilus. Transthoracic echocardiography revealed mitral regurgitation and multiple vegetations on the mitral valve. The patient was treated with a third-generation cephalosporin for 4 weeks and mitral valve replacement in view of the diagnosis of infective endocarditis and septic peripheral embolism. (Korean J Clin Microbiol 2009;12:82-86)

Keywords

Embolism and thrombosis, Endocarditis, Aggregatibacter aphrophilus