Pacemaker Related Infective Endocarditis from Staphylococcus Lugdunensis: A Case Report

Staphylococcus lugdunensis is a common skin flora not typically associated with infection. There are, however, several cases reported in the literature of Staphylococcus lugdunensis as a causative bacterium of various infections. This paper reports an additional case of pacemaker associated endocarditis with Staphylococcus lugdunensis as the causative bacterium. 1. Introduction Staphylococcus lugdunensis is a common skin flora that is seldom a causative organism of infection. It is a coagulase-negative staphylococcus that was first described in 1988 and has been associated with various community and nosocomial infections including native/prosthetic valve endocarditis, skin and soft tissue infections, catheter-related infections, ventriculoperitoneal shunt infections, prosthetic joint infections, and pacemaker related infections [1–4]. S. lugdunensis is proving to be more virulent than other coagulase-negative staphylococci, which is thought to be related to several of its unique abilities including the production of a toxin-like hemolytic peptide, adhesion promoting molecules, various enzymes, and biofilm formation [2]. It also produces a Von Willebrand bound binding protein that allows it to adhere to the endocardium endothelium lesions [2]. The frequency of S. lugdunnsis is likely underreported because it is easily confused with S. aureus through S. lugdunnsis’ ability to produce clumping factors and the fact that many labs do not further isolate out coagulase-negative staphylococci variants [2]. Fortunately, it is often susceptible to most antibiotics already used to treat other staphylococcal infections with little reported resistance. An estimated 25% of strains are capable of producing b-lactamase and even methicillin resistance is rarely reported [2]. 2. Case A 74-year-old Caucasian female presents to the emergency department of a local community hospital with a chief complaint of diarrhea for the past 3-4 days and a productive cough. All other review of systems was documented as negative. Her medical history was positive for hypertension, TIA, and an unspecified cardiac condition requiring a pacemaker. Her home medications included Bumetanide, digoxin, atorvastatin, carvedilol, lisinopril, and oral potassium supplement. Surgical and social histories were noncontributory. All history was obtained from the patient who was reported as alert and oriented for the duration of the emergency room stay. On initial presentation, her vital signs were as follows: a blood pressure of 131/84, pulse of 108, respiratory rate of 20, temperature of 38.6, and a