Infective endocarditis with neurological complications. Clinical case

Abstract

Introduction. Infective endocarditis (IE) is a serious infectious disease, with polyorganic complications, which causes a high risk of death (20-25%). In 20-40% of cases, IE is complicated by neurological disorders as: stroke, mycotic aneurysms, meningitis, cranial nerve paresis and cerebral hemorrhages. Aim of the study. Presentation of the patient's clinical case with infective endocarditis complicated by ischemic stroke. The importance of complex treatment in patients with IE with neurological involvement. Materials and methods. 59-year-old male, with IE caused by beta-hemolytic streptococcus with mitral valve (VM) involvement, hospitalized in the Institute of Cardiology in severe condition. From the anamnesis: onset with a stroke. Clinically and paraclinically examined by: blood cultures, ECOCG, clinical and biochemical analyses, consulted by a neurologist. Results. Fever 39oC, chills, motor aphasia, paresis on the right side. Objective(s).: pale skin, petechiae, Janeway lesions. Rhythmic heart murmurs, HR 90 b/min, systolic murmur at the apex and diastolic at the aorta, BP 90/50 mmHg. Paraclinically: BC beta-hemolytic streptococcus. ECOCG: mobile vegetations on MV 10 mm and AoV 12 mm; regurgitation on MV, VAo and VTs of grade III, EF 56%; Radiologically – bilateral septic pneumonia; Hb 89 g/l, erythrocytes 2.8x1012, leukocytes 11x109, ESR 66 mm/h; ASLO-1:400; FR 48 U/l. Treatment with 2 antimicrobial regimens in maximum doses, antifungals, diuretics, fractionated direct anticoagulants, nootropic medication. Conclusion(s). Infective endocarditis can often occur with polyorganic embolic complications, more frequently with stroke and pulmonary thromboembolism, which negatively influence the evolution and prognosis of the disease, causing disability. The treatment of these patients is complex and individualized.