Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10670-10680
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10670
Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature
Rui Tan, Jiang-Quan Yu, Jing Wang, Rui-Qiang Zheng
Rui Tan, Jiang-Quan Yu, Jing Wang, Rui-Qiang Zheng, Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
Author contributions: Tan R and Yu JQ were the patient's Cardiac Intensive Care Unit doctors, reviewed the literature, and contributed to the drafting of the manuscript; Wang J reviewed the literature and contributed to the drafting of the manuscript; Zheng RQ was responsible for revising the manuscript for important academic content; all authors issued final approval of the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jiang-Quan Yu, Doctor, Chief Doctor, Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, No. 98 Nantong West Road, Yangzhou 225001, Jiangsu Province, China.
Received: April 27, 2022
Peer-review started: April 27, 2022
First decision: June 27, 2022
Revised: July 11, 2022
Accepted: August 30, 2022
Article in press: August 30, 2022
Published online: October 16, 2022

Infective endocarditis (IE) is a rare disease with a high mortality rate. Leclercia adecarboxylata (L. adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae, and it can rarely be a pathogen which often affects immunodeficient patients. There are about three cases of immunocompetent patients with monomicrobial L. adecarboxylata infection. There are only three reported cases of IE caused by L. adecarboxylata in the world. The mitral valve is often affected in IE, and the prognosis for IE with mitral valve lesions is often poor.


A 51-year-old man was found to have moderate to severe mitral stenosis on echocardiography. He came to our Cardiothoracic Surgery Department for surgical management. A diastolic murmur was heard on auscultation of the heart in the mitral region. On the second day of hospitalisation, he presented with slurred speech, reduced muscle strength in the left limb, and acute cerebral infarction on cranial computed tomography. Surgical treatment was decided to postpone. On the ninth day of admission, the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit, where echocardiogram revealed an anterior mitral valve leaflet vegetation. After empirical anti-infective treatment with vancomycin (1g q12h), an emergency valve replacement was performed. Bacterial culture identified L. adecarboxylata. Anti-infective treatment with piperacillin-tazobactam (4.5g q8h) was added for 4 wk. Follow-up echocardiography showed normal bioprosthetic valve function after mitral valve replacement.


We report the first case of L. adecarboxylata IE in China, and clinicians should pay attention to this pathogen.

Keywords: Leclercia adecarboxylata, Infective endocarditis, Mitral valve, Vegetation, Cerebral infarction, Case report

Core Tip: Leclercia adecarboxylata (L. adecarboxylata) is a ubiquitous microorganism often found in water and soil and a rare pathogen can be isolated from specimens such as blood. We present a rare case of infective endocarditis caused by L. adecarboxylata that occurred in an immunocompetent male patient. He presented with clinical symptoms after diarrhoea. L. adecarboxylata was identified to be the only pathogen and the intestine may be the portal of entry for the infection. Immunosuppression is a significant risk factor for L. adecarboxylata infection. L. adecarboxylata is usually the only pathogen cultured in immunosuppressed individuals. Bacteria crossing the intestinal mucosal barrier may cause bacteremia.