An unusual infective endocarditis case presenting as meningitis in a young male with recent dental work

Abstract

Introduction: Infective endocarditis manifests in a variety of clinical presentations. Here, we present a case of infective endocarditis with uncommon presentation, unusual risk factors and rapidly progressing course that is important for clinicians to be aware of.
 Case: A 39-year-old healthy man presented for altered mental status, fever, and diffuse petechial rash. Ceftriaxone, vancomycin, and steroids were started for likely meningococcal meningitis. Blood cultures grew Staphylococcus aureus. His condition worsened with multiple complications. Transthoracic echocardiograms were negative for vegetations, but transesophageal echocardiogram finally showed a large aortic valve vegetation and aortic root abscess. Patient underwent cardiothoracic surgery and was successfully discharged home.
 Discussion: A high index of suspicion is required to quickly diagnosis IE. A detailed physical examination is paramount for correct diagnosis. TEE is superior to bedside TTE in such cases. IE can be complicated with intracardiac abscesses, septic shock, and presence of SAH.
 Key Words: Endocarditis, meningitis, petechial rash