Ivana Purnama Dewi, - and Ismail Damanik, - and Kristin Purnama Dewi, - and Mohammad Yogiarto, - and Andrianto, - (2021) Infective Endocarditis Caused by Streptococcus alactolyticus and Kocuria kristinae Complicated with Severe Thrombocytopenia: A Rare Case. Cardiologica Croatia, 16 (7-8). pp. 246-251. ISSN 1848-5448

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Abstract

SUMMARY: Introduction: Infective endocarditis (IE) is a focus infection caused by bacterial, viral, or fungal microorganisms within the heart that involves the endocardium and heart valves. Streptococcus alactolyticus, classified under DNA cluster IV of the S. bovis/S. equinus complex, is a sparse isolated bacterium that rarely cause IE in humans. Kocuria kristinae is a gram-positive bacteria. Until now, there have been only six IE cases caused by K. kristinae infections reported in the literature. Thrombocytopenia and platelet dysfunction can manifest in IE cases and are related to the clinical outcome. Different mechanisms have been hypothesized to explain thrombocytopenia in IE. Case report: We report the case of a 25-year-old female patient who complained of palpitation two weeks before admission. Initially, the patient complained of fever arising six months before admission. Blood cultures showed S. alactolyticus and K. kristinae. Echocardiography examination showed vegetation on anterior and posterior mitral valves with severe mitral regurgitation. During hospitalization, the patient also suffered from severe thrombocytopenia without bleeding signs. On day 16 after hospitalization, the patient suddenly complained of abdominal pain and dyspnea. The patient was declared deceased with cause of death due to septic emboli. Conclusion: We reported a case of IE caused by rare bacterial pathogens, S. alactolyticus and K. kristinae, which were aggravated by thrombocytopenia. Management of IE with thrombocytopenia requires caution because it is associated with poor outcomes. In this case, poor outcomes can be connected to thrombocytopenia coupled with the presence of specific bacteria, S. alactolyticus, which is known as a bacterium that often causes septic embolism.

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