Poor Outcome of Rare Lactobacillus Bacteremia and Endocarditis in a Patient With Frequent Consumption of Live Culture Yogurts.

Abstract

Lactobacillus rhamnosus is a gram-positive bacterium commonly found in dairy products and used as a probiotic due to its resistance to acid and bile. While generally considered safe, rare cases of L. rhamnosus bacteremia and endocarditis have been reported, primarily in individuals with significant risk factors. This report discusses an elderly male with a history of cardiovascular diseases, diabetes, and asthma, who developed L. rhamnosus bacteremia and endocarditis after consuming large quantities of Greek yogurt. The patient initially presented with fatigue, myalgias, and fever, and was treated empirically with cefepime and vancomycin. On that occasion, blood cultures recovered L. rhamnosus which was treated with a short course of oral antibiotics. Despite initial improvement, the patient was re-hospitalized with a transient cerebral ischemic attack. Subsequent investigations again revealed L. rhamnosus in blood cultures raising suspicion for subacute bacterial endocarditis. Antibiotic therapy with ampicillin resulted in the clearance of bacteremia; unfortunately, the patient experienced a non-ST elevation myocardial infarction leading to cardiac arrest and death. This case highlights the potential pathogenicity of L. rhamnosus in susceptible individuals and underscores the need for caution in consuming probiotic products among those with severe or multiple comorbidities.