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[A case of cerebral embolism caused by Cardiobacterium hominis endocarditis]

Seigo Shindo1, Teruyuki Hirano, Akihiko Ueda

  • 1Department of Neurology, Kumamoto University, Japan.

Rinsho Shinkeigaku = Clinical Neurology
|August 23, 2013
PubMed

Insights

A stroke caused by infectious endocarditis and Cardiobacterium hominis was difficult to diagnose due to mild symptoms. Early diagnosis of HACEK endocarditis is crucial for stroke patients.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Stroke diagnosis and treatment are time-sensitive.
  • Infectious endocarditis can present with subtle symptoms.
  • The HACEK group of bacteria are common causes of culture-negative endocarditis.

Observation:

  • A 45-year-old woman presented with left-sided hemiparesis due to a right middle cerebral artery (MCA) occlusion.
  • Diffusion-weighted magnetic resonance imaging (DWI) revealed a right frontal lobe lesion.
  • Brain magnetic resonance angiography (MRA) confirmed right MCA occlusion.
  • Intravenous rt-PA treatment was initiated but did not achieve recanalization.

Findings:

  • The patient was diagnosed with infectious endocarditis caused by Cardiobacterium hominis, a HACEK organism.
  • Echogenic vegetation was observed on the aortic valve.
  • Blood cultures were positive for C. hominis.
  • Fever and elevated C-reactive protein (CRP) were notably absent at admission.
  • A history of tooth extraction six months prior was identified as a potential source of bacteremia.

Implications:

  • This case highlights the diagnostic challenges of HACEK endocarditis, particularly when typical inflammatory markers are absent.
  • Subtle presentations of infectious endocarditis can lead to delayed diagnosis and treatment of associated cerebrovascular events.
  • Increased clinical suspicion for endocarditis is warranted in stroke patients, even with non-specific symptoms.
  • Prompt identification and management of infectious endocarditis are essential to prevent severe complications like stroke.

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