Cerebral infarction: Surgical timing dilemma in Streptococcus agalactiae endocarditis - A case report

Infective endocarditis (IE) is a relatively uncommon disease with a high mortality rate. Early recognition and prompt antibiotic therapy are crucial for preventing complications such as acute heart failure, uncontrolled infection, and embolic events. Embolic-related stroke events significantly increase both morbidity and mortality. Stroke may be the first clinical manifestation of IE. We report the case of a 57-year-old male who initially presented with stroke symptoms and left-sided weakness. His condition deteriorated rapidly and progressed to septic shock within 6 h. Broad-spectrum antibiotics were started at 13 h when "possible endocarditis" was diagnosed. Approximately 43 h after arrival, the patient developed atrioventricular block, ventricular fibrillation, and cardiac arrest, requiring 45 min of resuscitation. The surgical plan was changed from delayed surgery (originally scheduled for 4 weeks later) to emergency surgery that same day. Unfortunately, the patient developed intracranial hemorrhage on day 4 and died on day 13. The final diagnosis was "definite endocarditis" caused by Streptococcus agalactiae, which was confirmed by both pathological findings and three major clinical criteria (microbiological, imaging, and surgical).