Chen* and Hongcai Wang*
Department of Neurology, Binzhou Medical University Hospital, ChinaFulltext PDF
Streptococcus agalactiae (GBS) is an unusual cause of infectious endocarditis. At present, evidence suggests that the increasing impact invasive GBS disease occurs on adults. A 51-year old man, had a history of cirrhosis, fundus, esophageal varices, upper gastrointestinal bleeding for 11 years, with spleen resection, fundus and esophageal varices ligation. First clinical feature as right wrist and finger movement dysfunction with low-grade fever was described. Cerebral embolism induced by severe infectious endocarditis was confirmed by MRI+DWI in the early stage. The cardiac color Doppler showed the development of aortic valve vegetation (10 mm x 10 mm), which moved into the aortic sinus in systolic phase and the left ventricular outflow tract, severely affecting hemodynamics. STsegment depression in the ECG and the elevated serum troponin were indicated. Bacterial isolates from blood cultures revealed that Streptococcus agalactiae (Group B Streptococcus) infection. Despite the infection control and supportive treatment, the patient's condition continued to deteriorate, characterized by intermittent fever, chest pain, sitting breath and coughing up pink and foam sputum. Acute left heart failure was confirmed by echocardiography. The cardiac surgeries were complicated and have high risk. The patient eventually died of myocardial infarction and heart failure. Infectious endocarditis should be considered in patients without native valve disease who have cerebral infarction involving anterior and posterior circulation of cerebral artery and prolonged fever. Considering the severity of GBS infection, early recognition and prompt treatment was cardinal importance for the forward prognosis of infectious endocarditis.
Infective endocarditis (IE); Streptococcus agalactiae; Cerebral embolism; Heart failure
Zhang Q, Wang M, Xu W, Shi Z, Ma H, Ren A, et al. Atypical Septic Cerebral Embolism in the Fatal Infective Endocarditis. Neurol Case Rep. 2021; 4(1): 1023..