BackgroundLactococcus garvieae is a rare cause of infective endocarditis (IE) in humans and the bacterium can easily be misidentified. Intracranial haemorrhage often occurs in conjunction with IE, but subdural haemorrhage (SDH) is very rarely encountered.Case presentationThe patient was an 81-year-old male with a history of cardiovascular disease and a prosthetic biologic aortic valve. He presented with fatigue and an acute onset of headache. Computed tomography (CT) revealed a left-sided fronto-temporal subdural haematoma. Low-grade fever was noted and blood cultures yielded growth of L. garvieae. Transesophageal echocardiography (TEE) revealed small vegetations on the native mitral valve and on the prosthetic aortic valve. Treatment with penicillin and tobramycin was initiated and the recovery was slow but uneventful.ConclusionThis is the first report of a case where SDH was the sole presenting neurological sign of IE. The case demonstrates that IE should be considered in patients with SDH where a history of trauma is absent, especially if the patient has fever or predisposing conditions such as a prosthetic heart valve.

Bronchopulmonary dysplasia (BPD) is a pulmonary condition and developmental disease that has been associated with premature birth. It has been recognised since the 1960s. 1 Postnatal interventions, such as mechanical ventilation, oxygen, surfactant and systemic corticosteroids, can save lives, but some of these treatments may damage immature lung structures. 2 BPD is currently

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Objectives: This study aimed to map prescription patterns of pulmonary vasodilator therapy in children with bronchopulmonary dysplasia (BPD). Working hypothesis: Pulmonary vasodilator drug therapy is used in children born preterm suffering from BPD-associated pulmonary hypertension, but patient selection, extent of diagnostics with catheterization and co-morbidities are largely unknown. Study design: A descriptive national registry-based study. Patient selection and methodology: All children below seven years of age who had been prescribed a pulmonary vasodilator during a ten-year period, 2007-2017, born preterm (gestational age, GA <37 weeks) and classified as BPD, were included. Information on prescriptions was retrieved from the Swedish Prescribed Drug Register and information on patient characteristics and comorbidities was retrieved by linkage to national registers held by the National Board of Health and Welfare. Results: In total, 74 children were included, 54 (73%) born at GA 22-27 and 20 (27%) at GA 28-36. Single therapy was most common, N=64 (86.5%), and sildenafil was most frequently prescribed, N=69 (93%). Bosentan, iloprost, macitentan and/or treprostinil were mainly used for combination therapies, N=10 (13.5%). Patent ductus arteriosus (PDA) or atrial septal defect (ASD) was present in N=29 (39%) and N=25 (34%) children respectively, and N=20 (69%) versus N=3 (12%) underwent closure. Cardiac catheterization was performed in N=19 (26%) patients. Median duration of therapy was 4.4 (0.5-14.1, 95% percentiles) months. Total mortality was N=7 (9%). Conclusions: Preterm children with BPD are prescribed pulmonary vasodilators, often without prior catheterization and sildenafil was most common. Diagnostic tools, effects, and drug safety needs further evaluation.