{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:01:08Z","timestamp":1782982868769,"version":"3.54.5"},"reference-count":22,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,4]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>A 9-year-old child, with a background of repaired pulmonary atresia and Ebstein\u2019s anomaly, presented with fever, night sweats and lethargy. Blood cultures grew <jats:italic>Granulicatella elegans<\/jats:italic>, a nutritionally variant <jats:italic>Streptococcus<\/jats:italic> and known cause of infective endocarditis (IE). Echocardiogram revealed no clear vegetation, but increased stenosis of the right ventricle to pulmonary artery conduit. The child was successfully managed with high-dose benzylpenicillin, completing 2 weeks in the hospital, and was discharged to complete the \ufb01nal 4 weeks of therapy with ceftriaxone in the community, as per European Society of Cardiology guidance. IE caused by any <jats:italic>Granulicatella<\/jats:italic> species is rare, with infection due to <jats:italic>G. elegans<\/jats:italic> rarer still. It is a Gram-positive bacteria that presents a diagnostic challenge due to non-speci\ufb01c symptoms at presentation and di\ufb03culty in growing the organism on culture medium. We present a case of <jats:italic>G. elegans<\/jats:italic> endocarditis in a young child, which illustrates the challenges in managing this condition and the importance of considering atypical organism endocarditis in children presenting with fever of unknown origin, in particular those with a background of congenital cardiac disease. We review the literature on <jats:italic>Granulicatella<\/jats:italic> endocarditis, and brie\ufb02y discuss the challenges of managing this condition in a child with an autism spectrum disorder and learning di\ufb03culties.<\/jats:p>","DOI":"10.1136\/bcr-2020-240079","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T10:59:41Z","timestamp":1613645981000},"page":"e240079","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Challenges in the diagnosis and management of <i>Granulicatella elegans<\/i> endocarditis in a 9-year-old child"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4604-8806","authenticated-orcid":false,"given":"Victoria","family":"Holloway","sequence":"first","affiliation":[{"name":"Paediatrics, Royal Berkshire Hospital, Reading, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Jacob","sequence":"additional","affiliation":[{"name":"Microbiology, Royal Berkshire Hospital, Reading, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hayes","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology, Southampton University Hospitals NHS Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"2025082700130744000_14.2.e240079.1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jsha.2018.11.003","article-title":"Infective endocarditis in children with normal heart: indication for surgical intervention","volume":"31","author":"Nasser","year":"2019","journal-title":"J Saudi Heart Assoc"},{"key":"2025082700130744000_14.2.e240079.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001827"},{"key":"2025082700130744000_14.2.e240079.3","doi-asserted-by":"publisher","DOI":"10.1086\/515021"},{"key":"2025082700130744000_14.2.e240079.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000298"},{"key":"2025082700130744000_14.2.e240079.5","doi-asserted-by":"publisher","DOI":"10.1038\/191728a0"},{"key":"2025082700130744000_14.2.e240079.6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1099\/00207713-50-1-365","article-title":"The genus Abiotrophia (Kawamura et al.) is not monophyletic: proposal of Granulicatella gen. nov., Granulicatella adiacens comb. nov., Granulicatella elegans comb. nov. and Granulicatella balaenopterae comb. nov","volume":"50 Pt 1","author":"Collins","year":"2000","journal-title":"Int J Syst Evol Microbiol"},{"key":"2025082700130744000_14.2.e240079.7","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.039693-0"},{"key":"2025082700130744000_14.2.e240079.8","doi-asserted-by":"crossref","unstructured":"Kim SL , Gordon S , Shrestha N . 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