Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis

A case of Klebsiella oxytoca endocarditis in an intravenous drug user

“…IV drug use is uncommonly associated with non-HACEK Gram-negative endocarditis and was found in only 4% of cases [1]. This is only the third case reported in the literature of Klebsiella oxytoca endocarditis in an IV drug user, and only the second with no alternative identifiable source [3], [6]. In contrast, 57% of patients with non-HACEK Gram-negative endocarditis had a history of health care contact [1].…”

“…), compared to 17% for patients with infectious endocarditis of other causes [1]. The mortality rate associated with Klebsiella oxytoca endocarditis has not been established, however, of the 9 published cases there were three reported deaths that were either affiliated with or caused by the endocarditis [4], [5], [6].…”

“…Klebsiella species are responsible for prosthetic valve endocarditis more frequently than for native valve endocarditis, and involve the aortic valve in nearly two-thirds of cases [2]. Klebsiella pneumoniae is the species most commonly involved and Klebsiella oxytoca is rare, with only nine cases reported in the literature [3], [4], [5], [6], [7], [8], [9], [10], [11]. We present a case of Klebsiella oxytoca endocarditis in a 37-year old intravenous (IV) drug user.…”

A Importância do Conhecimento das Patologias Neurocirúrgicas na Perícia Médico Legal

“…Em raros casos ocorrem este tipo de hemorragia de forma espontânea, sem evidência de trauma 5,6 . Existem descrições na literatura como causa de hematoma subdural agudo sem trauma prévio, como por exemplo: a rotura de aneurisma, o hematoma intracerebral que invade o parênquima cerebral e ultrapassa a membrana aracnóide, e o embolismo séptico e asséptico ocasionando o sangramento 5 .…”

“…O quadro clínico clássico diante desta circunstância é descrito como cefaleia intensa súbita, perda de consciência e rigidez de nuca, dados semelhantes ao que foi descrito no relatório médico do caso apresentado 5,8 .…”