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37 EIKENELLA CORRODENS: A CASE OF BACTERIAL ENDOCARDITIS AFTER ACCIDENTAL TONGUE BITE.
  1. S. Jayawardena,
  2. A. P. Sethi,
  3. R. Patel
  1. Coney Island Hospital, Brooklyn, NY

Abstract

Introduction Eikenella corrodens is a facultatively anaerobic fastidious, gram-negative bacillus that is commonly found in human gingival flora. E. corrodens belongs to the HACEK (the acronym refers to a grouping of gram-negative bacilli) group of organisms, which also includes Haemophilusspp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, and Kingella kingae. About 3-5% of all endocarditis cases are reported to be caused be HACEK group of organisms.

Case Report An 86-year-old man was hospitalized with confusion since 1 day. Patient had accidentally bitten his tongue while eating a couple of days ago for which medical intervention was not needed. He was known to have idiopathic hypertrophic subaortic stenosis (IHSS). On physical examination he appeared confused and agitated with a temperature of 100.68F and soft systolic murmur in the aortic area, and the rest of the examination was normal. Blood tests showed absence of leukocytosis (7,300/μL) and rest of the blood tests were normal except for an elevated erythrocyte sedimentation rate (60 mm/hr). The chest radiograph showed cardiomegaly. Because of the history of IHHS therapy with broad-spectrum antibiotics (intravenous ampicillin sodium/sulbactam sodium, vancomycin, and ciprofloxacin) was initiated. Transesophageal echocardiography confirmed the diagnosis of IHHS with no vegetations. The blood culture done on admission grew gram-negative bacillus (2:2 bottles), which was later identified as Eikenella corrodens, sensitive to ampicillin/sulbactam, ciprofloxacin, and most of the cephalosporins. Because of the positive blood culture, predisposing heart condition, one episode of low-grade fever, and an elevated ESR, a diagnosis of possible endocarditis was made according to the modified Duke Criteria. Over the next few days he completely recovered and completed 4-week therapy with ceftriaxone.

Discussion Eikenella corrodens has a few common epidemiologic characteristics, which include infections in youngand middle-aged adults, dental manipulation or poor oral hygiene, underlying heart disease, anda preference for mitral valve. Except for the tongue bite our patient did not have any procedures done, which could have led to HACEK endocarditis. Embolic manifestations are commonly seen with HACEK endocarditis. The confusion and altered mentation in our patient could be attributed to embolization to the frontal lobe by valvular vegetation. In conclusion s high degree of suspicion is needed for the diagnosis of Eikenella corrodens as it can present with varied and nonspecific signs and symptoms.

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