Case Presentation: A 69 year old female, with a history of diverticulitis, recurrent urinary tract infections (UTI), presented to the emergency department (ED) for evaluation of rigors, chills, and myalgias, of one day duration. The patient denied any recent travels, and reported multiple sick contacts, including her mother who contracted COVID, and a cousin who was diagnosed with pneumonia. She denied any shortness of breath, abdominal pain, urinary symptoms, but reported a chronic cough. On initial presentation, the patient was found to be normothermic, normotensive, but tachycardic. She did not have a leukocytosis, and a comprehensive metabolic panel did not demonstrate any abnormalities. Computed tomography (CT) of her chest, abdomen, and pelvis demonstrated coronary artery calcifications, and diverticulosis, without diverticulitis. The patient’s urinalysis indicated a possible UTI, and the patient was started on amoxicillin-clavulanate, and discharged from the ED. Her urine subsequently grew Escherichia coli and Klebsiella pneumoniae, both of which were sensitive to amoxicillin-clavulanate. Two days after her ED discharge one of the two blood culture bottles grew gram negative rod bacteria and the patient was called back to the emergency department. She reported feeling symptomatically improved, and denied ongoing chills and rigors. The case was discussed with infectious disease (ID), who recommending continuing the current antibiotic regimen and repeating blood cultures. We discussed that the gram negative rods were likely a contaminant, and the patient opted to be discharged with close surveillance. Four days after her initial presentation the second blood culture bottle from the first visit was also positive for gram negative rod bacteria, and the first blood culture bottle speciated to Eggerthella lenta. The patient was notified, and at the time she reported new-onset diarrhea, stating that it felt similar to a flare of diverticulitis. She also reported severe fatigue. Given clinical decompensation, the patient was directly admitted and started on levofloxacin and metronidazole. Her repeat blood cultures did not grown any further bacteria.
Discussion: Eggerthella lenta (E. lenta, formerly known as Eubacterium lentum) is a slow-growing, anerobic, non-sporulating, gram-positive bacillus, which comprises part of the human biome. It is commonly found in the human gastrointestinal tract, female reproductive, oral cavity, and prostate gland. It has been documented to be the offending pathogen in bacteremia and intra-abdominal infections. E. lenta bacteremia, in particular, are associated with a high mortality, with rates between 20%-43%; risk factors for increased mortality include immunocompromised status, gastrointestinal diseases, and resistance to certain antibiotics. Co-infections with other anaerobes aren’t uncommon. Eggerthella spp. is generally sensitive to penicillins, metronidazole, and carbapenems. However, there is still a paucity of data in the management of E. lenta bacteremia.
Conclusions: Eggerthella lenta bacteremia, though rare, should be recognized as a potentially serious infection, and should not be dismissed as a contaminant. Prompt identification and tailored antimicrobial therapy are crucial, especially when co-infections with other bacteria occurs. Increased awareness may improve outcomes and guide diagnostic and therapeutic strategies of E. lenta.