Infective Endocarditis Presenting as Subarachnoid Hemorrhage: An Appeal for Caution.

Talal Asif,Amena Mohiuddin,Amgad Masoud,Badar Hasan

doi:10.7759/cureus.1176

Talal Asif, Amena Mohiuddin + Show 2 more

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https://doi.org/10.7759/cureus.1176

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Journal: Cureus	Publication Date: Apr 19, 2017
Citations: 2	License type: cc-by

Affiliation: University of Missouri–Kansas City

Abstract

Spontaneous subarachnoid hemorrhage (SAH) as the presenting feature of infective endocarditis (IE) is rare. It has classically been described in association with the rupture of intracranial mycotic aneurysms (ICMA). Here we describe a very rare case of non-aneurysmal spontaneous SAH in a patient with IE. The patient originally presented with a headache and low-grade fever. Neuroimaging including computed tomography (CT) and magnetic resonance imaging (MRI) of the head revealed SAH. She was eventually diagnosed with streptococcus gallolyticus (formerly streptococcus bovis) IE. Through this case, we advocate consideration of the diagnosis of IE in patients with SAH so that there is timely recognition of this reversible but serious disease.

Highlights

Spontaneous subarachnoid hemorrhage (SAH) as the presenting feature of infective endocarditis (IE) is rare
We report an interesting case of SAH without any identifiable source of hemorrhage or evidence of aneurysmal rupture
Our patient was eventually diagnosed with streptococcus gallolyticus IE

Summary

Introduction

Spontaneous subarachnoid hemorrhage (SAH) as the presenting feature of infective endocarditis (IE) is rare. The patient presented to the emergency room (ER) one week later with the complaint of weakness and mild generalized headache On physical examination, her blood pressure was 135/75, pulse 102 beats/minute, temperature 100.5°F and respiratory rate of 18/minute. The patient first underwent removal of her infected teeth after which TEE was performed which revealed a 0.9 × 0.7 cm vegetation on the posterior mitral leaflet with severe mitral regurgitation (Figures 2-3). Given the streptococcus bovis species bacteremia, colonoscopy was done which did not show any abnormality With treatment, her blood cultures became negative and her symptoms of headache, fever, and weakness resolved. SAH had resolved on follow-up MRI head one month later

Discussion

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Disclosures