An unusual infective endocarditis case presenting as meningitis in a young male with recent dental work

Michelle Zur; Anil Magge; Srinivas Nadadur; Ameer Rasheed

doi:10.12746/swrccc.v10i43.1011

Michelle Zur University of Connecticut
Anil Magge 2Pulmonary/Critical Care Fellowship, University of Connecticut School of Medicine, Farmington, CT 06030
Srinivas Nadadur Cardiology Fellowship, University of Connecticut School of Medicine, Farmington, CT 06030
Ameer Rasheed 4Assistant Professor of Medicine, Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT 06030

DOI: https://doi.org/10.12746/swrccc.v10i43.1011

Abstract

Introduction: Infective endocarditis (IE) has several clinical presentations. Here, we report a case of infective endocarditis with uncommon presentation, unusual risk factors, and a rapidly progressing course to alert clinicians to this scenario.

Case: A 39-year-old healthy man presented with altered mental status, fever, and a diffuse petechial rash. Ceftriaxone, vancomycin, and corticosteroids were started for possible meningococcal meningitis. Blood cultures grew Staphylococcus aureus. His condition worsened with multiple complications. Transthoracic echocardiograms (TTE) were negative for vegetations, but transesophageal echocardiogram finally showed a large aortic valve vegetation and aortic root abscess. The patient underwent cardiothoracic surgery and was successfully discharged home.

Discussion: A high index of suspicion is required to quickly diagnosis IE. A detailed physical examination is essential to establish the correct diagnosis. Transesophageal echocardiography is superior to bedside TTE in these cases. Infective endocarditis can be complicated with intracardiac abscesses, septic shock, and intracranial bleeding.

Keywords: Endocarditis, meningitis, petechial rash

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