A "fishy" situation, rare pathogen and presentation in prosthetic valve infective endocarditis.

Lactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time [1]. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve [1]. L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and poultry), but the route of human transmission remains unclear [3]. It seems to have a predilection for individuals with prosthetic valves, immunocompromised states, prior gastrointestinal surgery, gastrointestinal disorders (colon polyps and diverticulosis), and the use of acid-reducing medications [1-3]. Infective endocarditis is the most common systemic disease caused by L. garviae [1-4]. This report details the case of a 75-year-old male, with multiple comorbidities and risk factors for L. garviae infection who was admitted for "symptomatic anemia". High clinical suspicion, coupled with an inadequate hemoglobin response to transfusion, a normal anemia workup, and blood cultures positive for L. garviae, promoted a transesophageal echocardiogram (TEE). However, the results were negative. Consequently, an 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan (18FDG PET/CT) was performed. The scan revealed increased uptake in the aortic valve replacement consistent with prosthetic valve endocarditis in the setting of Lactococcus garviae bacteremia.

A Rare Presentation of Zinner Syndrome.

Zinner syndrome is a rare developmental anomaly of the distal Wolffian duct. It is characterized by a triad of unilateral renal agenesis, cysts in the ipsilateral seminal vesicle, and ipsilateral obstruction of the ejaculatory duct. While some patients are asymptomatic and diagnosed incidentally, other patients may present with symptoms related to obstructed ejaculatory ducts and seminal vesicle cysts. We report a unique case of a 32-year-old male who presented with pelvic pain for three days.

Daptomycin-Induced Acute Eosinophilic Pneumonia.

Antibiotic use in pneumonia is a common practice globally when there is suspicion for bacterial involvement. However, there have been few instances where the treatment is the cause of pulmonary symptoms, manifesting as so-called "multifocal pneumonia." Daptomycin is one of the main antibiotics known to have several adverse effects, including drug-induced pulmonary eosinophila. We present the case of a patient with probable daptomycin-induced acute eosinophilic pneumonia. Stopping the offending agent and concomitant steroid therapy resulted in resolution of symptoms and prevention of worsening respiratory distress.