NATIVE VALVE ENDOCARDITIS DUE TO CORYNEBACTERIUM-STRIATUM - CASE-REPORT AND REVIEW

We report the first known case of native valve endocarditis due to Cor ynebacterium striatum and review 51 previously reported cases of nativ e valve endocarditis due to non-diphtheriae corynebacteria. Of the 52 patients with corynebacterial endocarditis, 11 (21%) had no predisposi ng conditions and 27 (52%) had structural heart disease; endocarditis in the remaining 14 patients (27%) was associated with noncardiac pred isposing factors including injection drug use, chronic hemodialysis, v asculitis, alcoholism, liver transplantation and hemodialysis, a perit oneovenous shunt, and prior aspiration of a noninfected bursa. The mor tality rate associated with corynebacterial endocarditis was 31%. The majority of corynebacteria in this series were sensitive to penicillin , erythromycin, gentamicin, and vancomycin. Non-diphtheriae corynebact eria are capable of producing acute valvular damage, even in patients without conditions that are predisposing for endocarditis. The occurre nce of bacteremia due to non-diphtheriae corynebacteria in the appropr iate clinical setting should alert physicians to the possible diagnosi s of endocarditis. Empirical antibiotic therapy with vancomycin, with or without an aminoglycoside, should be initiated pending antibiotic s usceptibility testing.