we report the first french case of r.  aeria ie complicated by brain haemorrhage and femoral mycotic aneurysms , in an immunocompetent patient . a 57-year - old man born in nepal was hospitalized in january 2016 for fever reaching 39.4c , chills , diarrhoea and headache . he had a previous history , in 2008 , of right sub - thalamic ischaemic stroke and severe mitral insufficiency without ventricular dysfunction for dystrophic mitral valve . he did not have recent dental care and had no history of intravenous drug injections . at admission the patient presented with an already known 4/6 meso - systolic rough mitral murmur without cardiac failure and a painful erythema of the right hand ( fig . two aerobically incubated blood cultures performed at admission were positive with gram - positive branching filamentous bacilli ( fig . 1b , c ) within 41 and 86  h , as were the seven other blood culture sets . colonies were identified as r.  aeria using matrix - assisted laser desorption - ionization time - of - flight mass spectrometry ( see fig . trans - oesophageal echocardiography revealed mitral ie with several nearby vegetations of the ring base , flail p1 without heart dysfunction or abscess ( fig . pre - operative screening for systemic embolism showed a left frontal subarachnoid haemorrhage on brain magnetic resonance imaging and a hypermetabolic focus in the femoral artery compatible with a mycotic aneurysm on positron emission tomodensitometry ( fig . empiric antibiotherapy was introduced according to european guidelines   with intravenous amoxicillin 2  g every 4  h and gentamicin 3  mg / kg once a day . surgical mitral replacement by bio - prosthesis with annular reconstruction was performed according to the risk of cerebral embolism and cardiac abscess at day 10 after initiation of antibiotics . blood culture negativity was obtained at day 3 after antibiotics initiation and valvular culture was negative . 16s rrna gene sequence analysis was performed on the mitral sample and confirmed the identification of r.  aeria ( genbank accession sequence kx270977 ) with a maximal identity of 100% for r.  aeria type strain a1 - 17b ( genbank accession number ab071952 ) . antibiotic combination was maintained for 2 weeks , then amoxicillin alone for a further 4 weeks . subarachnoid haemorrhage regressed and trans - oesophageal echocardiography showed a good functioning of the prosthesis and the absence of added elements . initially r.  aeria was known as rothia dentocariosa genomovar ii   and could be mistaken for nocardia spp . except for its antibiotic sensitivity . infective endocardites due to r.  aeria ( n  =  7 ) and r.  dentocariosa ( n  =  25 ) , are reported to be associated with central nervous system involvement in 13 of the 32 cases ( 40% ) published , , . antibiotic susceptibility of the r.  aeria strains isolated in all case reports showed sensitivity for ampicillin and gentamicin . we report the first infective ie due to r.  aeria described in france and confirm that r.  aeria ie is serious and associated with mycotic aneurysms and central nervous system involvement . fast and aggressive management with an antibiotic combination including penicillin for 46 weeks , and valve replacement when necessary , is required and could limit the occurrence of complications and death .
rothia aeria is a rothia species from the micrococcaceae family . 
 we report here the first french r.  aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms . altogether 
 , severity and antimicrobial susceptibility should make us consider the management of r.  aeria endocarditis as staphylococcus aureus methicillin - susceptible endocarditis .