Staphalococcus lugdunensis endocarditis in a patient with ESRD

A 71 y/o woman w/ ESRD on HD sent to ED for altered mental status during dialysis. On arrival patient was slightly confused and lethargic. Despite suspicion of dialysis related volume shifts causing brain hypoperfusion, the team astutely sent blood cultures due to high risk of infection in dialysis patients. These returned positive for coagulase negative staphalococcus, and given her altered mental status and multiple positive cultures was unlikely to be a contaminant. Subsequent brain MRI showed multiple septic emboli consistent with endocarditis. Cultures eventually were speciated as Staphalococcus lugdunensis, an aggressive coagulase negative staph species that acts more like staph aureus.

For more information on this aggressive coagulase negative staphalococcus species read this concise article.