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Mannitol Anaphylaxis in the Setting of Septic Emboli-Induced Intracranial Hemorrhage
Barbara M Parker1, Vikash Priyadarshi2,3
1Clinical Pediatric Pharmacy/Clinical Pharmacy, AdventHealth Orlando, Orlando, USA.
Abstract:
Neurological complications are a significant problem in bacterial endocarditis. Cerebral embolism is the most frequent concern. Acute embolic disease may trigger focal seizures or mycotic aneurysms. Miliary infection is also common, and lumbar puncture can guide in determining the infective organism. Purulent cerebrospinal fluid (CSF) consists often of Staphylococcus aureus, a virulent organism, whereas non-virulent organisms (i.e., viridans streptococci) have normal CSF formulae. Microscopic abscesses suggest the potential for aneurysm from bacterial endocarditis amplifying the risk of intracranial hemorrhage. Mannitol and hypertonic (3%) saline are intravenous medications used as a rescue treatment for brain hemorrhage. A patient diagnosed with mycoplasma pneumonia and septic shock secondary to tricuspid endocarditis with extensive pulmonary emboli and metastatic infection to his spine was initiated on antibiotics. He developed a massive intracranial bleed from the rupture of mycotic septic emboli and was given mannitol to decrease intracranial pressure, which caused anaphylaxis.
Insights
Bacterial endocarditis can cause serious neurological issues like cerebral embolism and brain bleeds. Early diagnosis and treatment are crucial for managing these severe complications.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- Bacterial endocarditis frequently leads to neurological complications, with cerebral embolism being the most common.
- Neurological issues include focal seizures, mycotic aneurysms, and miliary infections, impacting patient outcomes.
- Lumbar puncture aids in identifying causative organisms, differentiating between virulent (e.g., Staphylococcus aureus) and non-virulent pathogens.
Observation:
- Microscopic abscesses in the brain indicate a heightened risk of aneurysm formation due to bacterial endocarditis.
- Intracranial hemorrhage can result from ruptured mycotic septic emboli.
- A case presented with mycoplasma pneumonia, septic shock, tricuspid endocarditis, pulmonary emboli, spinal metastasis, and subsequent massive intracranial bleed.
Findings:
- The patient received antibiotics for endocarditis and developed a massive intracranial bleed from ruptured mycotic septic emboli.
- Mannitol, used to reduce intracranial pressure, paradoxically caused anaphylaxis in this patient.
- This case highlights the complex interplay between endocarditis, neurological complications, and treatment side effects.
Implications:
- Effective management of bacterial endocarditis requires vigilant monitoring for neurological complications.
- Understanding the risk of mycotic aneurysms and intracranial hemorrhage is critical for patient care.
- Awareness of potential adverse reactions to treatments like mannitol is essential for managing severe cases.
