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A report is presented on a 53-year-old patient with endocarditis caused by Lactobacillus casei 9 years after prosthetic replacement of the aortic valve with a Björk-Shiley graft. In spite of a delay of about 6 weeks before therapy was started (due to difficulties in identifying the causative agent), treatment with a combination of penicillin G and gentamicin was effective and replacement of the artificial valve was not necessary. Seven months after cessation of therapy the patient is still free of symptoms. No other report of conservatively managed endocarditis due to lactobacilli and involving a prosthetic valve was found in the literature accessible to our group.
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