Cerebral ischemia caused by Streptococcus bovis aortic endocarditis: case report

Abstract

-Cerebral ischemic processes associated with infective endocarditis caused by S t re p t o c o c c u s bovis a re rare; only 2 cases having been re p o rted. Here we re p o rt a case of a 50-year-old man with S. bovis endocarditis who presented signs of frontal, parietal and occipital lobe cerebral ischemia. This is the first case re p o rted in which the presence of hemianopsia preceded the endocarditis diagnosis. Initially, the clinical manifestations suggested a systemic vasculitis. Later, vegetating lesions were identified in the aort i c valve and S. bovis g rew in blood cultures. Antibiotic use and aortic valve replacement eliminated the infection and ceased thromboembolic events. A videocolonoscopy examination revealed no mucosal lesions as a portal of entry in this case, although such lesions have been encountered in up to 70% of reported cases of S. bovis endocarditis.KEY WORDS: cerebral ischemia, hemianopsia, infectious endocarditis, Streptococcus bovis.Isquemia cerebral causada por endocardite aórtica pelo Streptococcus bovis: relato de caso RESUMO -A associação de isquemia cerebral e endocardite por S t reptococcus bovis é um evento raro, tendo sido publicados apenas 2 casos anteriormente. Nós relatamos o caso de um homem de 50 anos com e n d o c a rdite por S. bovis que apresentou sinais isquêmicos nos lobos frontal, parietal e occipital. Este é o p r i m e i ro caso em que a hemianopsia precedeu o diagnóstico de endocardite. Inicialmente, o quadro foi confundido com vasculite. Posteriormente, foi confirmada a presença de vegetações na válvula aórtica e a hemocultura identificou S. bovis. Os eventos tromboembólicos foram controlados com o uso de antibióti-cos e a troca da válvula aórtica. Estudo videocolonoscópico não identificou nenhuma lesão, apesar de lesões colônicas serem descritas em até 70% dos casos de indivíduos com endocardite por S. bovis. PALAVRAS-CHAVE: isquemia cerebral, hemianopsia, endocardite, Streptococcus bovis.S t reptococcus bovis is an important cause of bacteraemia and infectious endocarditis (IE) in adults. It is frequently accompanied by valvular abscess formation and systemic thro m b o e m b o l i s m . The bacterium usually attacks healthy cardiac valves and is frequently associated with colon neoplasm and other gastrointestinal mucosal lesions which are believed to provide the portal of entry into the systemic circulation for the S. bovis. It is not usually considered to be part of oral or colonic flora.We re p o rt a patient with cerebral ischemia in f rontal, parietal and occipital lobe territories caused by S. bovis endocarditis. CASEA 50-year-old Caucasian man presented with a weight-loss of 3 kg, myalgia, asthenia and dizziness over a three-week period. The subject drank alcoholic beverages in moderate amount and told that he did not smoke or used illicit drugs. Fever was not detected at any moment. Temporal hemianopsia was diagnosed in the right eye. Physical examination revealed a systolic h y p e rtension (150 mmHg), but was otherwise unre m a r kable. H...