Infective Endocarditis Leading to Intracranial Abscess: A Case Report and Literature Review

Abstract

Neurologic complications are a hallmark of infective endocarditis (IE). IE leading to intracranial abscess has an unfavorable prognosis. A 17-year-old boy with a past medical history of aortic valve replacement presented with fever and seizure. On examination, he had tachycardia, systolic murmur, slurred speech, meningeal signs, and right homonymous hemianopia. His laboratory analysis revealed an elevated erythrocyte sedimentation rate and C-reactive protein. The brain's magnetic resonance imaging revealed multiple ring-enhancing lesions in the frontal, occipital lobe, and occipitotemporal lobe, consistent with intracranial abscess. Transthoracic echocardiogram revealed a mobile mass adjacent to aortic value, consistent with possible infective vegetation. He was diagnosed with multiple cerebral septic emboli leading to intracranial abscess due to IE. Blood and cerebrospinal fluid culture revealed methicillinsensitive Staphylococcus aureus growth. He was started on intravenous nafcillin and gentamycin. His condition improved gradually, and he became afebrile on hospital day four. On his recent follow-up, he was doing well.

Multiple Brain Abscesses In A Child With Infective Endocarditis

“…Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections. 2 The findings of cardiac failure and acute renal failure in this case report are also compatible with complications of endocarditis already observed in the literature 1,6,12 .However, the absence of cardiac murmur and the markedly elevated blood pressure raised the question as to whether the heart failure was as a result of the renal complication or intracranial hypertension from the multiple macroabcesses (space occupying lesions) instead of a defective mitral valve.…”

“…A strict definition of infective endocarditis (I.E) could be confined to infection of the heart valves, septal defects and mural endocardium 1,2 Although in practice, it includes infection of the arterio-venous shunts, arterio-arterial shunts and coarctations as the clinical picture is usually indistinguishable. Though incidence is difficult to determine as it is not a notifiable disease, global estimates of IE is put at 3-10 per 100,000 people 3 .IE is highly lethal disease with overall mortality remaining at about 25% 3,4,5 The Duke's diagnostic criteria for infective endocarditis are as follows: "Definite" I.Ebased on (i).…”

“…between 25-70% occurrence of brain abscess appears to be relatively low( 1-7%) and is known to have unfavourable prognosis. 2,7 . Staphylococcus aureus (S. aureus) is the most common causative agent of IE.…”

“…Staphylococcus aureus (S. aureus) is the most common causative agent of IE. 2 The rarity of this condition coupled with the fact that the abscesses are predominantly macro-abscesses against frequently reported micro-abscesses ; and occurrence in a 3 year old who showed good response to medical and surgical intervention prompted the case report.…”

Surgical Atrial Septal Patch Endocarditis in a Patient with a Complete Corrected Atrioventricular Canal Defect: A Case Report and Review of the Literature

“…Regarding the brain abscesses, surprisingly, the neurological evolution in this case was completely asymptomatic, with the brain abscess resorbed under antibiotic treatment. Brain examinations, either CT or IRM, are crucial for the diagnosis of brain abscesses, as they are often clinically silent but can significantly worsen the prognosis [22][23][24]. In case of brain abscesses, surgery is often delayed and based on serial imaging and clinical progression, as the treatment for brain abscess is first and foremost with antibiotics to include MRSA coverage if the organism is not known [25].…”