Cerebral ring hemorrhages and a massive hematoma in a patient with infective endocarditis

Abstract

Letter to the Editor Cerebral ring hemorrhages and a massive hematoma in a patient with infective endocarditis Dear Editor, Cerebral ring hemorrhages (CRHs) are rounded, ringshaped hemorrhages occurring around small vessels. 1-3 CRHs are observed in various conditions and typically develop in the white matter, with most of the center portion containing thrombi or amorphic structures. 1-3 An 82-year-old man presented with a fever. Due to his medical history of transcatheter aortic bioprosthetic valve implantation and percutaneous coronary intervention, he was prescribed oral prasugrel. Vital signs and laboratory data indicated sepsis and disseminated intravascular coagulation (DIC), and methicillin-resistant Staphylococcus aureus was detected in the blood. Systemic computed tomography (CT) did not reveal any infectious foci. Roth spots, Osler's nodes, and Janeway lesions were not observed, and vegetation in the cardiac valves was not seen on transthoracic echocardiography. However, because infective endocarditis (IE) was suspected, he was treated with administration of antibiotics, intravenous infusion of immunoglobulin and recombinant human soluble thrombomodulin, and platelet transfusion. Unfortunately, intracranial hemorrhage developed on day 44 (Fig. 1A), and the patient died two days later. Autopsy