Pediococcus pentosaceus Endocarditis in a Patient With Recent Transcatheter Aortic Valve Implantation and Liver Cirrhosis: A Case Report and Review of the Literature.

Transcatheter aortic valve implantation (TAVI) is increasingly being used in the management of severe aortic stenosis, mainly in older and/or medically compromised patients, due to its minimally invasive nature. As in any valve replacement procedure, endocarditis is a recognized complication, more so in TAVI patients, in whom comorbidities are highly prevalent. We report the case of a 70-year-old male with a history of liver cirrhosis and a recent TAVI, who presented with recurrent fever and sustainedPediococcus pentosaceus bacteremia. The diagnosis of endocarditis was delayed, as the microorganism was initially discarded as a contaminant, given that Pediococci are rarely described as human pathogens. However, in cirrhotic patients, microbiota may cause intermittent bacteremia and thereby affect prosthetic valves. Transthoracic echocardiography was not helpful in validating the diagnosis, as is often the case in TAVI patients. Transesophageal echocardiography was deemed perilous, due to esophageal varices complicating the underlying cirrhosis. Therefore, endocarditis diagnosis was based on sustained bacteremia and Duke's criteria, including the presence of high fever, a predisposing cardiac lesion, splenic infarction, and the exclusion of an alternative diagnosis. Moreover, cirrhosis enhanced the side effects of treatment and led to the need for regimen changes and prolonged hospitalization. Given the precariousness of the situation, confirmation of treatment success by 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan was sought. This is the first reported case of Pediococcus TAVI endocarditis in a cirrhotic patient, highlighting the unique challenges in the diagnosis and management of TAVI endocarditis in patients with co-existing conditions.

Pyogenic Spondylodiscitis due to Streptococcus constellatus in an Immunocompromised Male Patient: A Case Report and Review of the Literature.

Pyogenic spondylodiscitis is a primary infection of the intervertebral disc and is a rare entity. Here, we describe the case of a 64-year-old male patient, a professional breeder, who attended the Emergency Department with sciatica and back pain that was worsening for a week. The patient had no history of surgery or trauma. The patient had poor oral hygiene. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures revealed Streptococcus constellatus. The patient was initially treated with vancomycin but due to renal failure deterioration, the treatment was changed to daptomycin for 8 weeks. During hospitalization, he endured renal injury and nosocomial respiratory tract infection. The patient was discharged with no further complications. Follow-up revealed improvement of neurological signs. In our case, it seems that poor oral hygiene was the cause of bacteremia, which underlies the importance of a good oral health status in immunocompromised patients not only to prevent but also to successfully eliminate any dental source of infection. S. constellatus is an extremely rare pathogen and to our knowledge only two other cases of pyogenic spondylodiscitis are reported in the literature. Early diagnosis is very important for the prognosis of these patients.

A case of acute pancreatitis possibly associated with combined salicylate and simvastatin treatment.

CONTEXT: Drug-induced acute pancreatitis is a rather rare clinical entity. From time to time, several cases have been reported in which statins or salicylates have been associated with the development of acute pancreatitis. There is only one report which implies the involvement of both drugs in pancreatic inflammation. CASE REPORT: A 58-year-old Caucasian male with a history of coronary heart disease and hypercholesterolemia, under treatment with acetyl-salicylate for 6 years and simvastatin for 2 months, presented to the Emergency Department of our hospital with epigastric pain and vomiting of 24-hour duration. The clinical and laboratory investigation led to the diagnosis of acute pancreatitis. Conservative and rich-in-fluid treatment resulted in clinical and laboratory amelioration, and the patient was discharged on day 15, after full restoration of his health. In our patient, all possible common causes of acute pancreatitis were excluded. CONCLUSION: Conclusion It is a rational assumption to connect this case to the co-administration of simvastatin and acetyl-salicylate. However, the pathophysiological mechanism behind the onset of acute pancreatitis due to a statin, or, even more, due to its combination with salicylate, remains vague.