Multiple embolization in infective endocarditis

A 67-year-old man presented to the emergency department with back pain, fever, and confusion. Suspecting of a meningoencephalitis, he was admitted and started on antibiotics. Vertebral MRI and lumbar puncture supported this initial hypothesis, while blood cultures resulted positive for a meticillin-sensitiveStaphylococcus aureus. On Day 3, a progressive neurological decline associated with multi-organ failure needing endo-tracheal intubation become evident. Cerebral contrast MRI showed small bilateral cortical microabscesses and subarachnoid haemorrhages (Panel A). Total body CT scan detected diffuse septic pulmonary infarcts as well (Panel B). On a clinical ground, peripheral embolic lesions were clear starting as Janeway lesions and evolving in diffuse finger ’s necrosis (Panel C). Roth ’s spots retinal haemorrhages were evident. Transoesophageal echocardiography confirmed a vegetation of the mitral valve (Panel D) that was interpreted as the original septic focus. Surgical valve replacement was indicated as urgent treatment and prolonged antibiotic therapy with floxapen is ongoing.
Source: European Heart Journal - Category: Cardiology Source Type: research