A Rare Case of Aggressive Infective Endocarditis Due to Corynebacterium striatum

Corynebacterium striatum is considered a rare pathogen in infective endocarditis (IE). C. striatum is a Gram-positive facultative anaerobic bacterium found in the environment and human flora. It is part of the microbiota of the skin and nasal mucosa of humans and has been increasingly reported as the etiologic agent of community-acquired and nosocomial diseases. A 91-year-old female patient was admitted to our clinic with complaints of increased fatigue for a week. Transthoracic echocardiography revealed a labile, echogenic appearance on the mitral valve that may be consistent with infective endocarditis, causing mitral regurgitation. Transesophageal echocardiography (TEE) confirmed this finding on the same day. In three-dimensional (3D) TEE, there was an oval mass of 1.9 cm × 1.1 cm at the level of the P2 scallop of the posterior mitral leaflet, and 1.0 cm of mobile vegetation was observed on it. Three serial blood cultures from peripheral vessels identified C. striatum. Antibiotic treatment of the patient was started with daptomycin 1 × 750 mg and meropenem 3 × 1 g. The cardiology team advised the patient to undergo early surgery, but the patient declined, and the case was followed up medically. On the 10th follow-up day, the patient had a speech disorder. Cerebral computed tomographic angiography showed an appearance compatible with a septic embolism in the left main cerebral artery. The patient's condition worsened throughout follow-ups, and she died on day 12. The purpose of presenting this case is to emphasize the importance of Corynebacterium species, which is a cause of rare native valve infectious endocarditis, and to show the difficulties in its treatment.