Granulicatella Causing Infective Endocarditis and Glomerulonephritis

Abstract

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.

Keywords

• Infective endocarditis
• Granulicatella
• Nutritional Variant Streptococcus
• Glomerulonephritis
• Mitral valve endocarditis