Case report of Staphylococcus lugdunensis native valve endocarditis and review of the literature.

INTRODUCTION: Coagulase-negative staphylococci, commonly Staphylococcus epidermidis, cause 5% of native valve endocarditis. We describe a case due to Staphylococcus lugdunensis, a coagulase-negative staphylococcus identified in 1988, as a first report in Southeast Asia. It was previously misidentified as S. aureus because it is sometimes slide coagulase positive, but always tube coagulase negative, resulting in its delayed recognition as a pathogen. We also reviewed 36 other cases reported in the English literature from 1988 to 1999.

CLINICAL PICTURE: Our patient was admitted 3 times over 4 months for unresolved weight loss and fever before the coagulase-negative staphylococcus bacteraemia was eventually considered significant.

TREATMENT AND OUTCOME: He was treated with 4 weeks of high-dose intravenous penicillin and 2 weeks of gentamicin and did not require urgent valve replacement.

CONCLUSION: A positive blood culture of coagulase-negative staphylococcus is not always a contaminant. S. lugdunensis can cause aggressive native valve endocarditis resulting in high mortality, especially without surgical intervention.