A 71-year-old male patient with a history of prostatectomy for Gleason 7 prostate adenocarcinoma (2 years ago), not carrying a Foley catheter and who was regularly monitored by the Urology Department after the operation. One year ago, he underwent cystoscopy for recurrent UTIs and underwent surgical dilatation for vesicourethral stenosis. Subsequently, she was diagnosed with paroxysmal atrial fibrillation due to severe aortic insufficiency caused by a bicuspid valve, and a valve prosthesis was fitted. Three months after the surgery, he came to the emergency department complaining of arthralgia, fever and new onset postvoid drip. Physical examination revealed splenomegaly and initial laboratory tests showed CRP: 26.9 mg/dL (reference values: 0-8 mg/dL), abundant bacteria and pyuria in the urinary sediment. Abdominal CT scan showed splenic infarction and biochemistry was expanded with troponin T: 319.6 ng/L (reference values: 0-14 ng/L), and pro-BNP: 45,140 pg/mL (reference values: 0-100 pg/mL). Microbiological study of urine in CLED culture medium showed no growth and Gram staining of urine identified gram-positive cocci. A blood agar culture was performed and gram-positive cocci colony growth was observed. Identification to genus and species level, Aerococcus urinae, was performed by MALDI-TOF mass spectrometry. In the 4 bottles of the two blood cultures there was also growth and the same micro-organism was identified. The antibiogram was as follows: sensitive to penicillin (MIC = 0.012 mg/L), cefotaxime (MIC = 0.064 mg/L), levofloxacin (MIC = 0.25 mg/L), vancomycin and linezolid. Transesophageal echocardiography showed evidence of prosthetic valve with perivalvular abscess. The patient initially received cloxacillin + gentamicin and later continued with ceftriaxone + daptomycin, with subsequent negative blood cultures. However, the clinical evolution, inflammatory markers and myocardial function were compatible with sepsis and acute pulmonary oedema, with fatal evolution towards irreversible ventricular failure. He finally died due to a rupture of the aortic annulus.
