Case Presentation: A 77 year old male with history of HTN, HLD, MR presented with two weeks of cervical neck pain, chills, neck stiffness, and malaise. Blood cultures drawn on admission grew a coagulase-negative Staphylococcus, which was later identified as Staphylococcus lugdunensis; an MRI of the spine was consistent with discitis. A TEE revealed a 15mm vegetation on his mitral valve. Cardiothoracic surgery was consulted and recommended a six-week course of cefazolin prior to surgical intervention. Several weeks after discharge, the patient was re-admitted prior to the completion of antibiotics for acute respiratory failure due to pulmonary edema. A repeat TEE revealed anterior mitral valve leaflet aneurysm and a perforation with moderate MR, as well as a persistent vegetation on the anterior leaflet of mitral valve and a new vegetation on the posterior leaflet. He underwent aortic valve replacement as well as mitral valve replacement emergently. Though he had some early post-operative complications requiring permanent pacemaker, the patient ultimately recovered and at recent clinic visits was reported to be doing well.
Discussion: Staph lugdunensis is a coagulase-negative staphyloccus species that is a rare cause of endocarditis. Coagulase-negative staphylococcal bacteremia is often associated with a less virulent clinical presentation than that of Staph aureus bacteremia; however, Staph lugdunensis bacteremia frequently progresses to endocarditis and metastatic spread of infection, with a clinical course similar to that seen in Staph aureus infections. Despite multiple case reports and literature reviews, no gold standard has been reached in terms of medical vs surgical treatment of Staph lugdunensisendocarditis. Often, despite the size of the vegetation, antibiotics are used to reduce the bacterial burden prior to surgery; however, this delay may increase the risk of complications associated with a higher mortality rate and/or requiring urgent surgical intervention, such as mitral valve aneurysm, as was seen in our patient.
Conclusions: Staphylococcus lugdenensis, a coagulase-negative Staphylococcus species, is a virulent and aggressive pathogen. There can be controversy surrounding the timing of cardiothoracic surgery for infective endocarditis. Clinicians should be aware that Staph lugdenensis shares more clinical features with Staph aureus than other coagulase negative Staphylococcus. This fact should enter into the decision as to when to proceed to surgery in patients with Staph lugdenensis endocarditis.
To cite this abstract:
STAPHYLOCOCCUS LUGDENENSIS: AN UNDERAPPRECIATED CAUSE OF RAPIDLY PROGRESSIVE NATIVE VALVE ENDOCARDITIS.
Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev..
Abstract 424Journal of Hospital Medicine Volume 12 Suppl 2.
https://shmabstracts.org/abstract/staphylococcus-lugdenensis-an-underappreciated-cause-of-rapidly-progressive-native-valve-endocarditis/.
December 18th 2025.