Cardioembolic Stroke at Prosthetic Valve Endocarditis

Abstract

Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. The risk of embolism is very high in IE, with embolic events occurring in 20-50%of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates. Case presentation: A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38 0C). He reported a history of recurrent fever lasting two days. His pre-existing comorbidities included Diabetes Mellitus, Arterial Hypertension and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with a recurrent fever up to 38.8 0C, no significant findings in the transthoracic echocardiogram (TTE), and positive blood cultures for Enterococcus faecalis. It was started an antibiotic therapy. Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke. Conclusion: Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it.