Rothia aeria bacteremia complicated by cerebral mycotic aneurysms: A case report

Background: Rothia aeria is a gram-positive bacterium that is considered a member of the normal human oral flora. Serious infections due to this organism are rare, with only eight case reports of endocarditis due to R. aeria published worldwide in the English language literature. Methods: We report the case of a previously healthy 43-year-old man who presented with multiple acute subarachnoid hemorrhages secondary to cerebral mycotic aneurysms after several weeks of weight loss and headache, and we summarize previously published cases of endocarditis due to R. aeria. Results: Blood cultures yielded filamentous gram-positive bacilli identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry as R. aeria. The patient was treated with antimicrobial therapy (initially aqueous penicillin G, then ceftriaxone) for 12 weeks with a good clinical response. Endocarditis was suspected but not definitively proven on echocardiography. There was no clear odontogenic source of infection. Conclusion: This report of cerebral mycotic aneurysms secondary to possible endocarditis highlights the potential pathogenic nature of R. aeria infection, and supports the use of MALDI-TOF in rapid identification of uncommon bacterial pathogens.