Infective endocarditis complicated with cerebral and splenic infarction in a hemodialysis patient

Abstract

BACKGROUND:Infective endocarditis (IE) has a high risk of morbidity and mortality. Complications are often due to systemic embolization. We treated a 47-year-old hemodialysis man with infective endocarditis complicated with cerebral and splenic infarction.METHODS:The patient was brought to the emergency department because of altered mental status and fecal incontinence. Although he did not meet the Duke Criteria for IE diagnosis, clinical suspicions of IE warranted further diagnostic studies. Magnetic resonance imaging of the brain revealed cerebral infarction with abnormal neurological findings. An abdominal computerized tomography revealed an incidental and unexpected splenic infarction without physical findings. Echocardiography revealed a vegetative growth (−1.2×1 cm) over the mitral posterior leaflet with severe mitral valve regurgitation. Based on these results, the patient was diagnosed with IE complicated with severe cerebral and splenic infarction.RESULTS:The patient was treated with intravenous teicoplanin including gentamicin, subcutaneous low molecular weight heparin, and oral acetylsalicylic acid. Mitral valve replacement surgery was performed after the patient improved clinically.CONCLUSION:Emergency physicians should be aware of the life-threatening complications of IE, which may be presented subtly or without clinical evidence.

Vancomycin-Resistant Enterococcus Endocarditis Complicated by Splenic Infarction and Embolic Stroke

“…The spleen is particularly vulnerable to infarction due to its lack of collateral circulation. Splenic infarction occurs in approximately 40% of left-sided IE cases, with 90% of splenic infarcts and abscesses having no symptoms [ 1 ]. Neurological complications of embolic IE may also occur and include stroke, transient ischemic attack, meningitis, and intracranial hemorrhage.…”

“…Neurological complications of embolic IE may also occur and include stroke, transient ischemic attack, meningitis, and intracranial hemorrhage. In fact, the central nervous system is the most common site for embolic events with an incidence rate of up to 65% [ 1 ]. It would have been commonplace if this patient was diagnosed with a single embolic complication of IE; however, the finding of a splenic infarct and stroke in the presence of VRE endocarditis makes this case relatively unusual, and management in such cases is not well-established.…”

“…Atilla et al presented a case of a 47-year-old man on hemodialysis who developed IE on the mitral valve complicated by splenic and cerebral infarction and was treated with intravenous teicoplanin, gentamicin, subcutaneous low-molecular-weight heparin, and oral acetylsalicylic acid. When the patient improved clinically, mitral valve replacement was performed [ 1 ].…”

“…Infective endocarditis (IE), defined by a focus of infection within the endocardial surface of the heart, is associated with a high risk of morbidity and mortality, with its prognosis highly dependent on complications [ 1 , 2 ]. In the United States, IE occurs in about one per 33,000 people, predominantly affecting males (50-65% of patients), with an average age at presentation between 52-63 years.…”

Surgical Treatment of Infective Endocarditis, Complicated with Splenic Abscesses

“…Staphylococcus aureus, Streptococcus species, and Enterococcus faecalis are the most common microorganisms. Blood cultures are negative in less than 5% of patients with IE [4]. Prior antibiotic therapy, inadequate microbiological techniques, or infection with highly fastidious bacteria or fungi could be associated with culture-negative endocarditis [5].…”