Abstract
Neurologic complications are a hallmark of infective endocarditis (IE). IE leading to intracranial abscess has an unfavorable prognosis. A 17-year-old boy with a past medical history of aortic valve replacement presented with fever and seizure. On examination, he had tachycardia, systolic murmur, slurred speech, meningeal signs, and right homonymous hemianopia. His laboratory analysis revealed an elevated erythrocyte sedimentation rate and C-reactive protein. The brain's magnetic resonance imaging revealed multiple ring-enhancing lesions in the frontal, occipital lobe, and occipitotemporal lobe, consistent with intracranial abscess. Transthoracic echocardiogram revealed a mobile mass adjacent to aortic value, consistent with possible infective vegetation. He was diagnosed with multiple cerebral septic emboli leading to intracranial abscess due to IE. Blood and cerebrospinal fluid culture revealed methicillin-sensitive Staphylococcus aureus growth. He was started on intravenous nafcillin and gentamycin. His condition improved gradually, and he became afebrile on hospital day four. On his recent follow-up, he was doing well.
Highlights
Infective endocarditis (IE) is linked to significant cardiac and non-cardiac morbidity
Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections
IE's neurologic complications can be divided into four main categories: hemorrhagic infarct, ischemic infarct, intracranial infection, and mycotic aneurysm
Summary
Infective endocarditis (IE) is linked to significant cardiac and non-cardiac morbidity. We present a case of IE and brain abscess as a noncardiac complication of IE caused by the spread of the multiple septic emboli. A 17-year-old boy presented to the emergency department with fever and mental status change, associated with rigors and chills, nausea, vomiting, arthralgia, and generalized headache He was a known case of subaortic stenosis in his early life and managed with surgery at four. Cranial nerves were intact except the optic nerve, which revealed right homonymous hemianopia His initial laboratory showed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of 95 mm/hr and 13 mg/dL, respectively. His thyroid-stimulating hormone (TSH) level was nonsignificant, and Epstein-Barr virus (EBV), human immunodeficiency virus (HIV), and monospot tests all were negative.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
