Abstract
Background: Bacterial endocarditis is a rare infectious entity with a very heterogeneous clinical spectrum; neurological manifestations are the most frequent and serious extracardiac complications of infective endocarditis. However, little is known about the psychiatric manifestations and / or sequels due to septic embolism of the infective endocarditis. Case Report: 50-year-old male, history of arterial hypertension and nephrolithiasis with recurrent urinary tract infections. He began his condition with behavioral changes characterized by marked impulsivity and instability in his interpersonal relationships, adding repetitive events of fever and nephrolithiasis requiring urological interventions and antibiotic therapy. Upon admission assessed by psychiatry because of his impulsive behavior and emotional changes with the presumptive diagnosis of borderline personality disorder. Conclusion: In the following work we describe the first case found in the literature of a psychiatric manifestation in a male patient as the initial complication of a subacute bacterial endocarditis, his diagnostic approach, clinical picture and therapeutic outcome. The early recognition of the clinical picture and the diagnostic approach allowed to establish effective antibiotic treatment; to recognize that bacterial endocarditis might present in a multifaceted way allows to suspect this disease and give treatment opportunely to reduce its burden and mortality.
Highlights
Bacterial endocarditis is a rare infectious entity with a very heterogeneous clinical spectrum; neurological manifestations are the most frequent and serious extracardiac complications of infective endocarditis
In the following work we describe the first case found in the literature of a psychiatric manifestation in a male patient as the initial complication of a subacute bacterial endocarditis, his diagnostic approach, clinical picture and therapeutic outcome
The disease remains to be a challenge for the physician because of the multifaceted clinical presentation and multiple system and organs that can be affected at the beginning of the disease alongside its different prognosis and evolution depending on the microbiology of the I.E and its initial complications [1]
Summary
Infective Endocarditis (I.E) is an uncommon but well study disease that can affect multiple systems and organs, associated by an infection (bacteria most of the time) of the enodcardial surface [1]. Because the neurological complications are the most frequent ant lethal form of extracardiac I.E , we report the first case to our knowledge, of a 50-year-old man who presented at the emergency department with sub-acute behavioral changes and a presumptive diagnosis of Borderline Personality Disorder (B.P.D) made on the initial examination [4]. The neuropsychiatric team has addressed his psychiatric symptoms and behavioral changes and he continues rehabilitation with a good prognosis
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