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A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly., (Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

A 66-year-old woman with a history of tissue aortic valve replacement and chronic back pain presented to the emergency department with a suspected right leg deep vein thrombosis. A recent outpatient MRI had revealed discitis. A ventricular fibrillation cardiac arrest occurred in the emergency department. Cardiac output was restored on the fifth defibrillation. A transthoracic echocardiogram showed large aortic valve vegetations. Clinical impression was of infective endocarditis with cardiac arrest secondary to coronary artery embolisation. Peripheral blood cultures grew Cardiobacterium hominis, and appropriate intravenous antibiotic therapy was administered. The infected prosthetic valve was excised. The patient experienced postoperative complete heart block and a right hemisphere cerebrovascular accident, however she is now recovering well. This case describes an unusual case of infective endocarditis secondary to C. hominis, with disc, leg, coronary artery and brain septic embolisation. Infective endocarditis is an important differential diagnosis in multisystem presentations., (2014 BMJ Publishing Group Ltd.)

A case of prosthetic aortic valve endocarditis due to Cardiobacterium hominis in a 67-year-old woman is described. The diagnosis was confirmed by a positive blood culture and echocardiographic detection of aortic valve vegetations. The patient underwent replacement of the valve with a homograft, and received antibiotics postoperatively. She remained well after 12 months.

Cardiobacterium hominis, a member of the HACEK group of organisms, is a rare cause of endocarditis. We report a case of infective endocarditis caused by C. hominis in a male child who had undergone right ventricular outflow tract (RVOT) reconstruction using an expanded polytetrafluoroethylene conduit for tetralogy of Fallot with pulmonary atresia. Two days before admission, the patient suffered from exertional shortness of breath. Right ventricular hypertension was confirmed and RVOT stenosis was suspected based on the echocardiography findings. A CT scan revealed vegetation above the cusp of the conduit. An emergency operation was performed to avoid a pulmonary embolism due to large friable vegetation. C. hominis was cultured from the blood and the vegetation, prompting a diagnosis of prosthetic valve endocarditis. The patient was discharged after a 6-week course of intravenous ceftriaxone therapy.

Cardiobacterium valvarum was isolated from the blood of a 71-year-old man with fatal aortic valve endocarditis. The API NH system was used for phenotypic characterization of the C. valvarum strain. This is the first case of infective endocarditis caused by C. valvarum in Germany and the first case worldwide affecting a prosthetic valve and lacking an obvious dental focus.