Infective endocarditis presenting as meningitis: a case report

Infective endocarditis (IE) primarily affects the endocardium of heart valves. Neurologic manifestations include strokes, intracerebral hemorrhages, meningitis, cerebral and spinal abscess, and mycotic aneurysms. Although rare, meningitis is a potentially life-threatening complication of IE, so physicians should be aware of this rare and fatal complication of IE.

Here, the authors present a case of a 53-year-old male who presented with bacterial meningitis secondary to IE. His blood culture was positive for methicillin-sensitive staphylococcal aureus. Echocardiography findings were suggestive of endocarditis. Despite aggressive intensive care management, our patient did not survive.

The isolation of Staphylococcus aureus in culture should raise a suspicion of foci being elsewhere outside the central nervous system. Treatment of complications like meningitis may require intrathecal antibiotics. The vegetation and neurological complications are often difficult to treat and require the participation of a multidisciplinary team.

The diagnosis of IE in patients presenting with neurologic deficits and fever should be considered. A physician should raise a suspicion of infective foci being elsewhere outside the central nervous system if the organism isolated in culture is Staphylococcus aureus.