<i>Corynebacterium striatum</i> and the deceptive diagnosis in a dialysis-dependent chronic liver disease patient: A case report

BACKGROUND Corynebacterium striatum is a non-diphtherial corynebacterium commonly regarded as commensal skin flora and frequently dismissed as a blood culture contaminant. In recent years, it has emerged as an opportunistic pathogen capable of causing severe invasive infections, including infective endocarditis, particularly in patients with indwelling intravascular devices and immune dysfunction. CASE SUMMARY A 46-year-old man with decompensated chronic liver disease (Child-Pugh C; Model for End-Stage Liver Disease-Na 36 on admission) and end-stage renal disease on maintenance haemodialysis presented with acute-on-chronic dyspnoea and hypotension following a recent prolonged hospitalisation and dialysis catheter placement. Initial blood cultures were sterile, and baseline echocardiography findings were normal. On day 10 of admission, he developed refractory septic shock. Repeat blood cultures grew Corynebacterium striatum in multiple sets. Transthoracic echocardiography revealed large mobile vegetations involving the mitral and tricuspid valves, with severe regurgitation, consistent with multivalvular infective endocarditis. Surgery was considered too high risk due to advanced cirrhosis (Model for End-Stage Liver Disease-Na 40) and haemodynamic instability. Despite targeted intravenous vancomycin therapy and supportive care, the patient deteriorated and succumbed to multiorgan failure. CONCLUSION Corynebacterium striatum should not be dismissed as a contaminant when isolated repeatedly from blood cultures in vulnerable patients. Early recognition, prompt echocardiographic evaluation, and aggressive multidisciplinary management are essential, as this seemingly benign organism can cause rapidly progressive and fatal native-valve endocarditis.