6 0196-4399/00 (see frontmatter) © 2010 Elsevier Clinical Microbiology Newsletter 32:1,2010 Introduction Members of the genus Moraxella are normal commensals of the human upper respiratory tract and are occasionally recovered from the skin and mucous membranes. Moraxella lacunata has been associated with human conjunc- tivitis and keratitis but rarely with inva- sive and serious infections (1). However, a few case reports have established that M. lacunata organisms cause invasive infections in humans, including infec- tive endocarditis (IE) (1-3), septicemia, septic arthritis, spondylodiscitis, and meningitis (4). In this report, we describe a patient who, after receiving a tattoo, developed M. lacunata endocarditis with cardiovascular complications, resulting in valve replacement surgery. This is the first report in Latin America of M. lacunata-induced endocarditis confirmed by sequencing of the 16s rRNA gene directly from heart valve tissue. Case Report A 34-year-old female was admitted to the Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina, for evaluation of fever and dyspnea. Her previous medical history was un- remarkable, and she had no history of valvular disease. Three weeks prior to admission and 4 days before the onset of fever, she was tattooed on her back. Physical examination showed that the patient was febrile with signs of heart failure and class IV dyspnea (New York Heart Association classification). Cardiac auscultation revealed a mitral holosystolic murmur. Examination of her skin and the tattoo revealed no sign of inflammation. Laboratory tests showed a white blood cell count of 14,800/mm 3 with 80% neutrophils, a hematocrit of 29%, a platelet count of Mailing Address: Dr. Raquel Callejo, Bacteriologia Especial, INEI-ANLIS “Dr. Carlos G. Malbran,” Av. Velez Sarsfield 563 Ciudad Autónoma/C1282AFF, Buenos Aires, Argentina. Tel./Fax: 54 11 4303 2333. E-mail: rcallejo@anlis.gov.ar Case Report Moraxella lacunata Infective Endocarditis after Tattooing as Confirmed by 16S rRNA Gene Sequencing from Heart Valve Tissue Raquel M. Callejo, Ph.D., 1 Francisco Nacinovich, M. D., 2 Mónica A. Prieto, Ph.D., 1 Sandra Lambert, M.D., 2 Carla Vizzotti, M.D., 2 Hugo Villar, Ph.D., 2 Matías Sztejfman, M.D., 3 Daniel Navia M.D., 3 and Daniel Stamboulian, M.D. 21 Servicio Bacterología Especial, Instituto Nacional de Enfermedades Infecciosas ANLIS “Dr. Carlos G. Malbrán, ” 2 Servicio de Infectología y Control de Infecciones, Instituto Cardiovascular de Buenos Aires (ICBA), and 3 Departamento de Cardiología y Cirugía Cardiovascular, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina