Blood Culture-Negative but Clinically Diagnosed Infective Endocarditis Complicated by Intracranial Mycotic Aneurysm, Brain Abscess, and Posterior Tibial Artery Pseudoaneurysm.

Chao Jiang,Li Zhu,Haibin Lu,Wendy Ziai,Jian Wang,Tianqi Luo,Yaoqiang Guo

doi:10.1155/2018/1236502

Abstract

Blood culture-negative endocarditis is often severe and difficult to diagnose. It is necessary to emphasize the importance for the early diagnosis and accurate treatment of blood culture-negative endocarditis. Here, we described the relevant clinical information of a blood culture-negative but clinically diagnosed infective endocarditis complicated by intracranial mycotic aneurysm, brain abscess, and posterior tibial artery pseudoaneurysm. This patient was a 65-year-old man with a 9-month history of intermittent fever and died in the end for the progressive neurological deterioration. Although the blood culture is negative, this patient was clinically diagnosed as infective endocarditis according to Duke criteria. This patient course was complicated not only by cerebral embolism, intracranial mycotic aneurysm, and brain abscess but also by posterior tibial artery aneurysm of the lower extremity. The clinical findings of this patient suggest that the confirmatory microbiology is essential for the treatment of blood culture-negative infective endocarditis. Clinicians should be aware of the detriment of blood culture-negative infective endocarditis for its multiple complications may occur in one patient. The delayed etiological diagnosis and insufficient treatment may aggregate the clinical outcome of blood culture-negative infective endocarditis.

Highlights

Infective endocarditis (IE), with mortality rates of 20% to 40%, is the most frequently encountered endocarditis [1, 2]
Previous reports have indicated that blood culture-negative endocarditis is not common, and few studies have reported the correlation between blood culturenegative IE and neurological complications
Blood culture-negative IE refers to endocarditis without etiology after three blood samples incubated on standard media [5]

Summary

Introduction

Infective endocarditis (IE), with mortality rates of 20% to 40%, is the most frequently encountered endocarditis [1, 2]. Many cases of IE are clinically silent and are recognized in only 2-10% of patients with eventual diagnosis of infective endocarditis [1, 2]. Neurological complications of IE, occurring in 20-40% of cases, can be classified into the following categories: meningitis-encephalopathy, ischemic complications, cerebral hemorrhage, and brain abscess [1]. Most complications occur in blood culture-positive infective endocarditis, and most patients only experience one or two neurological events during the IE episode [1]. Previous reports have indicated that blood culture-negative endocarditis is not common, and few studies have reported the correlation between blood culturenegative IE and neurological complications. We report a blood culture-negative but clinically diagnosed patient with IE complicated by three neurological and one peripheral complication

Case Report

Discussion

Findings

Conflicts of Interest