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A 59-year-old man presented with right flank and buttock pain. Magnetic resonance imaging of the pelvis demonstrated right sacroilitis (See Figure 1: A, circle) and myositis without obvious abscess (B, arrow). Blood cultures subsequently grew Granulicatella adiacens which was sensitive to penicillin MIC 0.064 mg/L. Echocardiography showed a dilated ascending aorta measuring 4.9 cm and a functional bicuspid aortic valve with a 6 mm \u00d7 9 mm mobile mass on the ventricular aspect of the non-coronary cusp consistent with vegetation (C, D, arrows). Severe aortic regurgitation was noted which is likely chronic as the ventricle was dilated at 6.1 cm. Computed tomography (CT) of aorta confirmed a severely dilated aortic sinus measuring 5.0 cm (E). CT angiography showed mild eccentric calcified atherosclerotic plaque in the left anterior descending artery. He underwent aortic root replacement and recovered well. Granulicatella adiacens (F) is a nutritionally variant streptococcus associated with high morbidity and mortality in endocarditis. Early surgical intervention should be considered when Granulicatella adiacens endocarditis is diagnosed. This case highlights the utility of multimodality imaging in the evaluation of patients with endocarditis and in guiding treatment. Learning points Embolisations are frequent in Granulicatella adiacens endocarditis and therefore possess a diagnostic and management challenge to clinicians. Pre-existing cardiac pathology is a risk factor in endocarditis due to Granulicatella and most commonly affects aortic and mitral valves.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology; Phil Weeks, Department of Radiology; Ruvin Gabriel, Department of Cardiology; Niels van Pelt, Department of Cardiology, Middlemore Hospital, Auckland

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand

Correspondence Email

enLi.Looi@middlemore.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 59-year-old man presented with right flank and buttock pain. Magnetic resonance imaging of the pelvis demonstrated right sacroilitis (See Figure 1: A, circle) and myositis without obvious abscess (B, arrow). Blood cultures subsequently grew Granulicatella adiacens which was sensitive to penicillin MIC 0.064 mg/L. Echocardiography showed a dilated ascending aorta measuring 4.9 cm and a functional bicuspid aortic valve with a 6 mm \u00d7 9 mm mobile mass on the ventricular aspect of the non-coronary cusp consistent with vegetation (C, D, arrows). Severe aortic regurgitation was noted which is likely chronic as the ventricle was dilated at 6.1 cm. Computed tomography (CT) of aorta confirmed a severely dilated aortic sinus measuring 5.0 cm (E). CT angiography showed mild eccentric calcified atherosclerotic plaque in the left anterior descending artery. He underwent aortic root replacement and recovered well. Granulicatella adiacens (F) is a nutritionally variant streptococcus associated with high morbidity and mortality in endocarditis. Early surgical intervention should be considered when Granulicatella adiacens endocarditis is diagnosed. This case highlights the utility of multimodality imaging in the evaluation of patients with endocarditis and in guiding treatment. Learning points Embolisations are frequent in Granulicatella adiacens endocarditis and therefore possess a diagnostic and management challenge to clinicians. Pre-existing cardiac pathology is a risk factor in endocarditis due to Granulicatella and most commonly affects aortic and mitral valves.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology; Phil Weeks, Department of Radiology; Ruvin Gabriel, Department of Cardiology; Niels van Pelt, Department of Cardiology, Middlemore Hospital, Auckland

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand

Correspondence Email

enLi.Looi@middlemore.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 59-year-old man presented with right flank and buttock pain. Magnetic resonance imaging of the pelvis demonstrated right sacroilitis (See Figure 1: A, circle) and myositis without obvious abscess (B, arrow). Blood cultures subsequently grew Granulicatella adiacens which was sensitive to penicillin MIC 0.064 mg/L. Echocardiography showed a dilated ascending aorta measuring 4.9 cm and a functional bicuspid aortic valve with a 6 mm \u00d7 9 mm mobile mass on the ventricular aspect of the non-coronary cusp consistent with vegetation (C, D, arrows). Severe aortic regurgitation was noted which is likely chronic as the ventricle was dilated at 6.1 cm. Computed tomography (CT) of aorta confirmed a severely dilated aortic sinus measuring 5.0 cm (E). CT angiography showed mild eccentric calcified atherosclerotic plaque in the left anterior descending artery. He underwent aortic root replacement and recovered well. Granulicatella adiacens (F) is a nutritionally variant streptococcus associated with high morbidity and mortality in endocarditis. Early surgical intervention should be considered when Granulicatella adiacens endocarditis is diagnosed. This case highlights the utility of multimodality imaging in the evaluation of patients with endocarditis and in guiding treatment. Learning points Embolisations are frequent in Granulicatella adiacens endocarditis and therefore possess a diagnostic and management challenge to clinicians. Pre-existing cardiac pathology is a risk factor in endocarditis due to Granulicatella and most commonly affects aortic and mitral valves.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology; Phil Weeks, Department of Radiology; Ruvin Gabriel, Department of Cardiology; Niels van Pelt, Department of Cardiology, Middlemore Hospital, Auckland

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand

Correspondence Email

enLi.Looi@middlemore.co.nz

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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