Case Presentation: An 80 year-old male with a past medical history of hypertension, hyperlipidemia, coronary artery disease with previous coronary artery bypass graft 4 years prior, and chronic diastolic heart failure presented with three days of acute onset weakness, abdominal pain, and subjective fevers. Patient had a fall one month prior to presentation and had been largely bed bound and developed a stage 1 decubitus ulcer. Computed tomography (CT) of the abdomen and pelvis revealed mild inflammatory changes in the left lower quadrant concerning for acute colitis and the patient was empirically started on piperacillin-tazobactam. Subsequently, the patient had an acute multifocal cerebral vascular accident. Transesophageal echocardiogram revealed mitral valve vegetations, severe mitral insufficiency with flail chordae suggestive of cardioembolic source for multifocal stroke. The patient was deemed to be a high surgical risk. Blood cultures grew Corynebacterium jeikeium and the patient was switched to vancomycin. The pt’s respiratory status worsened presumably due to severe mitral regurgitation, and the patient was transitioned to hospice.
Discussion: Corynebacterium jeikeium is a gram positive bacillus commonly present on the skin surface. Immunocompromised patients may become bacteremic secondary to contamination of indwelling lines, post coronary angiography or open heart surgery and it causes a predominantly left sided valvular endocarditis. The treatment of choice is vancomycin, though case reports documenting usage of daptomycin or linezolid have also had positive outcomes. C. jeikeium has a higher likelihood to require valve replacement compared to endocarditis secondary to other corynebacterium. Despite treatment, mortality rates of C. jeikeium infection have been shown to be as high as 33%. Upon a thorough review of the literature, we found only a handful of case reports where this bacteria caused endocarditis in an immunocompetent patient.
Conclusions: Corynebacterium jeikeium is commonly present on the skin surface and when it is exposed to the blood can cause endocarditis, usually in immunocompromised patients. It is important that physicians are aware of this rare cause of endocarditis in immunocompetent patients.