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Large vegetations are usually seen in cases of fungal endocarditis and most cases of bacterial endocarditis are associated with a single or multiple small vegetations, most of which are usually too small to be visible on a transthoracic echocardiogram.
We present a case of a middle-aged man with a prior history of moderate rheumatic mitral regurgitation who had a history of having received complete treatment for bacterial endocarditis. The patient presented for valve replacement surgery for severe symptomatic mitral regurgitation which had been worsened by the endocarditis. The patient had a giant vegetation attached to the mitral valve which was 2.2×1.6 cm (see figures 1 and 2 and online supplementary videos 1–4).
The endocarditis was caused by a rare organism, Kocuria rosea, which is a Gram-positive coagulase-negative coccoid actinobacteria belonging to the family Micrococcaceae. The organism is typically a commensal and is often isolated from soil and water. It has occasionally been implicated in urinary tract infections and may cause systemic infection in immunocompromised patients.1 Cases of endocarditis caused by Kocuria rosea have rarely been reported,2 and there are no reports of the presence of giant vegetation caused by this organism. There have been rare reports of patients having giant vegetations with bacterial endocarditis caused by Streptococcus and Staphylococcus.3 ,4
The patient underwent successful mitral valve replacement and has been stable during follow-up. This case illustrates the fact that the mere presence of a giant vegetation, although suggestive, is not definitive for fungal endocarditis and may even may be seen in the case of organisms conventionally considered atypical for endocarditis.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Files in this Data Supplement:
- Data supplement 1 - Online video 1
- Data supplement 2 - Online video 2
- Data supplement 3 - Online video 3
- Data supplement 4 - Online video 4
Footnotes
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Contributors All the authors contributed to the drafting and finalising of the manuscript and to patient care.
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Funding Funded by institutional funds.
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Competing interests None.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.