# Gemella sanguinis: A Rare Cause of Endocarditis in a Bicuspid Aortic Valve

## TL;DR

A 50-year-old man with a bicuspid aortic valve developed rare Gemella sanguinis endocarditis after dental work, highlighting the need for high clinical suspicion in such cases.

## Contribution

This case highlights Gemella sanguinis as a rare but important cause of endocarditis and emphasizes the need for better diagnostic awareness.

## Key findings

- Gemella sanguinis was identified as the causative agent of infective endocarditis in a patient with a bicuspid aortic valve.
- The patient's extensive dental history and bicuspid aortic valve acted as risk factors for the infection.
- The case underscores the importance of maintaining high clinical suspicion for rare pathogens in diagnosing endocarditis.

## Abstract

Here, we present a case of infective endocarditis (IE) caused by Gemella sanguinis, a pathogen that rarely causes human infection. The patient in this case was an otherwise healthy 50-year-old man who presented with gradually worsening shortness of breath, weight loss, fatigue, chills, and leg swelling for six weeks. He had no prior history of cardiac disease and had never used intravenous drugs, but he had undergone extensive dental work following a military-associated injury. A workup for IE was done, and echocardiography revealed a bicuspid aortic valve (BAV) with vegetations causing moderate to severe aortic regurgitation. Blood cultures, which initially showed only gram-positive cocci, later identified Gemella sanguinis. He subsequently recovered after receiving treatment with antibiotics and undergoing an aortic valve replacement. The patient’s BAV and significant dental history acted as risk factors for this condition, and although his symptoms were nonspecific and he did not exhibit other classic risk factors for IE, his case represents the importance of keeping high clinical suspicion to allow for prompt initiation of appropriate treatment. More research on Gemella is needed, as these species are difficult to identify and therefore may be a more significant cause of infection than is currently known.