Infective endocarditis presenting as febrile stroke and complicated with multi-territorial systemic embolization in a young woman: A case report

Infective endocarditis (IE) is a life-threatening condition frequently complicated by systemic embolization, most commonly involving the central nervous system, spleen, and kidneys. In a young patient, a febrile ischemic stroke should be considered infective endocarditis until proven otherwise, given the diagnostic and prognostic stakes of an early diagnosis. Multi-territorial embolic dissemination at presentation, however, remains uncommon and carries substantial clinical implications. We report the case of a 49-year-old woman with an undocumented mitral valve disease who presented with acute left hemiparesis and a one-month history of high-grade fever. Brain MRI revealed an acute ischemic stroke of the right middle cerebral artery territory. Transthoracic and transesophageal echocardiography demonstrated mobile vegetations on the mitral valve, and blood cultures isolated Streptococcus species, establishing a definite diagnosis of infective endocarditis. Contrast-enhanced CT of the brain, chest, abdomen, and pelvis, together with spinal MRI, revealed extensive systemic embolization involving five distinct vascular territories: a cerebral septic embolic focus, splenic and renal infarction, a mycotic aneurysm of the ileocolic artery, and infectious spondylodiscitis. This case underscores that a febrile ischemic stroke in a young patient warrants urgent screening for infective endocarditis, and highlights the value of a systematic, whole-body imaging work-up in detecting clinically silent embolic complications and guiding patient management.