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Background  Infective endocarditis caused by  Actinomyces  spp. is extremely rare. However, cases by new species of  Actinomyces  have been increasingly reported due to advances in laboratory techniques, and many of these species do not cause classic presentations of actinomycosis.  Actinomyces neuii  is reported to have a tendency to cause endovascular infection. The course of infective endocarditis caused by  Actinomyces  spp. is usually indolent.    Case presentation  A 61-year-old man with history of infective endocarditis, end stage renal disease, and monoclonal gammopathy was admitted for an abrupt fever, confusion, dysarthria, and facial droop after hemodialysis. Echocardiogram showed vegetations on both the aortic and mitral valves. Two sets of blood culture grew  A. neuii . Brain MRI showed multiple bilateral cerebral infarcts consistent with septic emboli. The patient recovered after valvular surgery and prolonged intravenous and oral antibiotic therapy.    Conclusions  This case illustrates an unusually acute presentation of  A. neuii  infective endocarditis. As with other Gram-positive bacilli,  Actinomyces  spp. isolates are often regarded as a result of contamination. One should keep it in mind as a cause of infective endocarditis in vulnerable patient populations.

Actinomyces neuii: a case report of a rare cause of acute infective endocarditis and literature review