A rare infective endocarditis caused by Vagococcus fluvialis

A 70-year-old male with a past history of coronary artery bypass grafting, presented with high-grade fever and rapidly progressive dyspnea for 3 days. He was febrile and a prominent diastolic murmur was noted in the aortic area. Transesophageal echocardiography showed severe aortic regurgitation with multiple mobile vegetations attached to both supra- and infravalvular surfaces of aortic valve. Blood cultures grew Vagococcus fluvialis which was confirmed with identification and antibiotic susceptibility test testing and S16 RNA sequencing. The patient underwent aortic valve replacement with a bioprosthetic valve. Repeat blood culture was sterile. He was continued on vancomycin injections for a total period of six weeks. Vagococcus is a unique genus of Gram-positive, catalase-negative, facultatively anaerobic cocci that was identified in 1989. The only other documented case of vagococcal endocarditis involving mitral and aortic valves had a similar rapidly progressive presentation with extensive valvular damage. V. fluvialis infection appears to have fulminant course with sudden deterioration requiring surgical intervention.