Erysipelothrix rhusiopathiae: Blood, bones, and the beating heart

Erysipelothrix rhusiopathiae, a Gram-positive bacillus, infrequently causes human infections. While localized cutaneous infections are most common, they can also lead to septicemia and/or endocarditis. In this case report, we discuss a patient initially presenting with back pain, confusion, and forgetfulness worsening over the month preceding admission. She was found to have a complex E. rhusiopathiae infection involving bacteremia complicated by bioprosthetic aortic valve endocarditis, native mitral valve endocarditis, lumbar discitis and osteomyelitis, and an abscess. The patient was noted to have a penicillin allergy, so ceftriaxone was chosen for appropriate coverage. The patient was not deemed a candidate for surgical or procedural interventions, so treatment with a six-week course of intravenous ceftriaxone was initiated, and she was noted to have resolved her infection with no further complications. This case not only adds to the sparse data on E. rhusiopathiae infections involving endocarditis and osteomyelitis but also prompts reconsideration of management strategies in the aging population with multiple comorbidities and implanted devices.