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Streptococcus constellatus Left Ventricular Apical Mural Infective Endocarditis With Acute Stroke, Septic and

Eric Hilker1, Sachin M Patil2, Zach Holliday3

  • 1Department of Medicine, University of Missouri School of Medicine, Columbia, USA.

Cureus
|March 28, 2022
PubMed

Insights

Infective endocarditis caused by Streptococcus constellatus is rare, especially presenting as acute encephalopathy from septic emboli and a left ventricular mural vegetation. This case highlights an unusual presentation of a common infection by an uncommon pathogen.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Neurology

Background:

  • Infective endocarditis (IE) is a severe cardiac infection, with Streptococci causing most community-acquired native valve cases.
  • Streptococcus constellatus is an uncommon cause of IE, rarely affecting prosthetic valves.

Observation:

  • A middle-aged male with diabetes presented with acute encephalopathy, initially suspected as stroke.
  • Transthoracic echocardiogram showed a left ventricular apical mural vegetation; brain imaging revealed multiple small strokes.
  • Blood cultures confirmed high-grade bacteremia due to S. constellatus.

Findings:

  • The patient experienced acute encephalopathy secondary to multiple septic emboli, a rare manifestation of IE.
  • Primary mural infective endocarditis with S. constellatus was diagnosed, presenting unusually with severe neurological symptoms.
  • This case represents a rare clinical scenario involving an uncommon etiological agent and infrequent echocardiographic findings.

Implications:

  • This case underscores the importance of considering infective endocarditis in patients with unexplained neurological deficits, even with atypical presentations.
  • It highlights S. constellatus as a potential pathogen in IE, particularly in immunocompromised individuals or those with cardiac abnormalities.
  • The findings suggest that prompt diagnosis and treatment are crucial for managing IE and preventing severe complications like stroke.

Keywords:
bacteremiainfective endocarditismural vegetationstreptococcus constellatusstroke

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