Letter to the Editor
The pitfall of coagulase-negative staphylococci: A case of Staphylococcus lugdunensis endocarditis

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Abstract

We report a case of a 60-year-old woman. She was transferred from a local hospital to our cardiovascular medicine department with a diagnosis of infectious endocarditis due to Staphylococcus lugdunensis. Transthoracic echocardiograph confirmed the presence of large vegetations on the native aortic and mitral valve, and subsequent severe regurgitation due to the aortic and mitral valve destruction. Emergent operation was performed and patient's life was barely rescued.

However, S. lugdunensis belongs to coagulase-negative staphylococci, which are generally regarded as relatively avirulent bacterium, the endocarditis caused by S. lugdunensis can be invasive and often resembles endocarditis due to Staphylococcus aureus. Therefore, whenever this organism is found in patients with endocarditis, early surgical treatment of the infected valve should be considered.

Introduction

Staphylococcus lugdunensis is a coagulase-negative staphylococcus that was first described by Freney et al. in 1988 [1]. It was named after Lyon (Latin adjective of Lugdunum), the French city where the organism was first isolated. S. lugdunensis is commonly found on the human skin and is a rare contaminant in cultures [2]. Although coagulase-negative staphylococci are generally considered nonpathogenic commensals in immunocompetent hosts or in the absence of indwelling foreign bodies, S. lugdunensis is a well-characterized exception due to its markedly aggressive nature [3]. S. lugdunensis is a relatively rare cause of endocarditis, but has been previously described as causing acute endocarditis with a high mortality rate [4].

In this report, we describe a case of native aortic and mitral valve endocarditis caused by S. lugdunensis that required emergency surgery, and discuss the virulent pathogenesis of S. lugdunensis.

Section snippets

Case report

We report a case of a 60-year-old woman who was transferred to our cardiovascular medicine department with a diagnosis of infectious endocarditis due to S. lugdunensis in March 2005. Her past medical history included hypertension, liver cirrhosis of unknown etiology, and a surgery for spinal dural arteriovenous fistula in 2002. At the end of February 2005, she caught a cold and ran a fever. On March 3, the patient was diagnosed with bronchitis and was admitted to a local hospital. At that time,

Discussion

Clinical manifestations of infections due to coagulase-negative staphylococci markedly differ from those of Staphylococcus aureus infections. Normally, the clinical picture is subtle and non-specific, and the clinical course is more subacute or even chronic without fulminant signs of infection. Coagulase-negative staphylococcal bacteremia is rarely life threatening, especially if treated promptly and adequately [3]. Nevertheless, S. lugdunensis is a well-characterized exception due to its

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