TABLE 1.
Timeline of events in 65‐year old liver transplant candidate with Weissella confusa endocarditis
| Day 1 | Presented with altered mental status, weakness, fatigue with 20 pounds weight loss |
| Temperature 36.6 Celsius; Physical exam – asterixis, slightly distended abdomen, systolic murmur | |
| Key Labs: | |
| White blood cells 13,400/μl (H) with neutrophil (75.2%) (high) | |
| Hemoglobin 10.1 g/dl | |
| Creatinine 1.24 mg/dl | |
| Aspartate transaminase 43 IU/L (H) | |
| Alanine aminotransferase 18 IU/L | |
| Alkaline phosphatase 138 IU/L (H) | |
| Total bilirubin 1.4 mg/dL (H) | |
| MELD sodium score = 18 | |
| MELD score = 14 | |
| Child‐Pugh Classification C | |
| Liver ultrasound showed an unremarkable gallbladder with no ascites | |
| Day 2 | Blood culture x 2 positive for Weissella confusa |
| Started IV vancomycin | |
| Day 3 | Repeat blood culture positive for Weissella confusa |
| Switched IV vancomycin to IV ampicillin | |
| Day 4 | Repeat blood culture negative. |
| Switched ampicillin to penicillin for 2 weeks due to suspected endocarditis | |
| Transthoracic echocardiogram – thickened aortic and mitral valve | |
| Day 6 | Transesophageal echocardiogram showed new thickened aortic valve stenosis with moderate aortic regurgitation. |
| PET showed minimally elevated FDG activity adjacent to the aortic valve favored to be adjacent myocardial activity. No focal hyperintense uptake at TIPS or gallbladder region. | |
| Repeat blood culture negative on day 8 | |
| Day 16 | Hospitalized with hemorrhagic shock due to duodenal bleeding. |
| Endoscopy showed a 2 cm flat based ulcer in the second part of the duodenum. | |
| Day 19 | Switched to oral amoxicillin‐clavulanate for 4 weeks per infectious disease team |
| Day 46 | Completed 6 weeks of antibiotic treatment |
| Day 48 | Hospitalized with abdominal pain and leukocytosis presumably from a splenic infarct seen on CT abdomen. |
| Repeat echocardiogram showed thickened aortic valve (healed endocarditis) and mild to moderate aortic insufficiency | |
| Patient discharged next day without antibiotics | |
| Day 147 | Hospitalized with Gemella sanguinis bacteremia complicated by aortic and mitral valve endocarditis with valvular destruction, and multifocal stroke from septic emboli |
| Started on penicillin G and vancomycin | |
| Patient deemed not to be a cardiac surgical candidate due to underlying liver condition | |
| Day 157 | Death |
Abbreviation: MELD; Model For End‐Stage Liver Disease, PET; positron emission tomography, FDG; fluorodeoxyglucose, CT; computed tomography.