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Fatal Lactobacillus species may translocate from the gastrointestinal tract into systemic circulation from ingested probiotics or commensal flora. Their pathogenic potential is still debated. Lactobacillus endocarditis is a rare entity with only around 120 cases reported in the literature. Here, we report the first case of fatal Lactobacillus endocarditis with involvement of a transcatheter aortic valve replacement with the following goals: to reaffirm the pathological significance of Lactobacillus spp, to demonstrate the potential limitations of the modified Duke criteria in diagnosing infective endocarditis of transcatheter aortic valve replacement, and to urge clinicians to aggressively search for and consider empiric treatment for endocarditis in patients with prosthetic valves who develop Lactobacillus bacteraemia.

Fatal We report the case of a 76-year-old female patient with early breast cancer (hormone receptor-positive erbb2 amplified) that had started adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH). Eight days after the first cycle of TCH chemotherapy, the patient was diagnosed with grade 1 oral mucositis, treated conservatively. The next day she started with nausea, vomiting, chills and fever, followed by a generalised tonicoclonic seizure. She presented to the emergency department with fever, hypotension and mild abdominal tenderness. Grade 4 neutropenia (370 μL/mL) and severe metabolic acidosis were documented. An abdominal CT scan documented extensive ischaemic bowel changes, with gas in portal and mesenteric veins, and pneumoretroperitoneum. Despite broad spectrum antibiotics and fluid resuscitation, she died 4 hours after admitted to hospital. Blood cultures collected on hospital admission eventually grew Clostridium septicum bacteria, an extremely rare infection in patient with breast cancer.