A 73-year-old man presented with fever.
She had a history of hypertension and dyslipidemia.
Ten years before admission, she had undergone valve replacement for aortic stenosis with a metallic prosthesis and one year ago an aneurysmal dilatation of the ascending aorta with a valved tube.
The patient also had colonic colitis (with a recent onset without alterations).
She had no recent history of dental, urological, digestive or other procedures.
The patient went to the farm, raised cows and non-stabulated horses.
Interrogate directedly described that two weeks prior to the current situation, a mare had delivered a dead fetus.
Suddenly, 24 h before going to the emergency room, he had high fever (at 39°C) with chills, associated with poor general condition.
She reported no cough, odynophagia, dysuria, or gastrointestinal symptoms.
Physical examination revealed a fever of 38°C, with the rest of the vital signs normal.
Decay, eupneic, well perfused.
There were no cutaneous or conjunctival stigmata.
From the rest of the exploration, the surgical scar of the medial anastomosis stood out, and in the cardiac auscultation, a metallic aortic valve click and a mitral systolic murmur.
Laboratory tests included a complete blood count with leukocytes of 10.640/mm3 (neutrophils), INR 2, biochemical tests with no relevant changes.
A chest X-ray and an abdominal ultrasound were normal.
Transthoracic echocardiography showed a normal functioning aortic valve prosthesis, with no stenosis or insufficiencies and no images suggestive of endocarditis.
The mitral valve showed thickened leaflets, with nodular thickening of 3 mm in the auricular face of the anterior leaflet at the ring level, barely mobile.
It was complemented with a transesophageal echocardiogram, which reported infectious endocarditis on the mechanical prosthesis in aortic position, normal functioning aortic prosthesis, mild mitral valve insufficiency II/IV.
The hemocultiva was positive by isolating large p-hemolytic colonies (> 0.5 mm diameter), buffering sorbitol, classified in group C of Lancefield® by a latex agglutination test (Str.).
The isolation was confirmed by BIOL GP2 (BIOL Inc, Hayward, USA) panels with 95 carbon sources.
A similarity of 99.6 % (T=0.899) was found.
A fragment of 1395 bp of the 16srRNA gene was sequenced using a previously described method.
The sequence obtained showed 99.4% homology with S. equis subsp. zooepidermicus (n° GenBANK: NR_102812, CP001129 and others).
The patient was initially treated empirically with penicillin and gentamicin.
Once susceptibility was demonstrated in the antibiogram and completed two weeks with gentamicin, it was maintained with penicillin exclusively until completing six weeks, with a favorable outcome.
In the post-treatment transesophageal echocardiogram, the mechanical prosthesis was normal functioning and the previous vegetations were not visualized.
After one year of follow-up the patient remains asymptomatic.
