2023 Volume 45 Issue 5 Pages 426-431
We describe a case of infective endocarditis (IE) caused by Lactobacillus rhamnosus. A 34-year-old man without any basic disease complained of headache, and left intracranial hemorrhage was pointed out with a CT scan. After admission, his blood cultures proved Lactobacillus rhamnosus, and vegetations on the aortic valve were detected in the transthoracic echocardiography. He was diagnosed with infective endocarditis, and intracranial hemorrhage was extrapolated from the rupture of intracranial mycotic aneurysms. He had eaten over ten times larger amount of yogurt than that of recommended, and this consumption was thought to be the cause of Lactobacillus bacteremia. Antibiotic therapy was administered, but new right intracranial hemorrhage was detected during hospitalization. Contrast-enhanced CT revealed an aneurysm in the hemorrhage. The mycotic aneurysm had gradually grown, so a trapping of the aneurysm was performed at 21 days after admission. Aortic valve replacement was performed at 33 days after admission. Persisted fine motor deficit and higher brain dysfunctions remained; he changed the hospital for continuing rehabilitation. Lactobacillus rhamnosus are broadly available as probiotic products, and there are a few case reports about IE by Lactobacillus rhamnosus caused by excessive consumption of yogurt. We should keep in mind that such excess intake of yogurt-related products may cause IE and detailed questions about medical history may help us to diagnose.
