Introduction: Endocarditis is associated with high mortality and severe complications. Most of the patients have preexisting structural cardiac abnormality at the time of the endocarditis development. Complications of the infective endocarditis can be cardiac, neurologic, renal, and musculoskeletal, as well as complications related to systemic infection. The management of such patients includes both antibiotic therapy and surgical treatment, as long as it is indicated.
Case presentation: A previously healthy 30-year-old man, was recently examined in the neurology department for episodic diplopia, headache and fever, which started 3 weeks ago and persisted despite antibiotic treatment. The cerebral CT was normal, and he was addressed to our clinic for further investigations.The physical examination revealed a grade 2/6 diastolic aortic murmur. Laboratory findings at admission revealed inflammatory syndrome. Transthoracic echocardiography revealed possible bicuspid aortic valve with severe aortic regurgitation, without vegetations or intracavitary cardiac masses. Transesophageal echocardiography confirmed the existence of bicuspid aortic val-ve with severe aortic regurgitation and postero-inferior aortic cusp abscess. Two blood culture samples both yielded Gram-positive rods. Empirical antibiotic treatment was started, and after complete identification of the bacteria as Streptococcus thoraltensis, the patient was directed to the Infectious Disease Clinic. The positive diagnosis of endocarditis was made both on major criteria (positive blood cultures, intracardiac abscess) and minor criteria (fever, predisposing heart condition). With antibiotic therapy, the patient progressively improved, and after that, he underwent cardiac surgery with aortic valve replacement.
Conclusions: The presented case highlights an infective endocarditis which developed on a bicuspid aortic valve and was discovered by chance, with a particular clinical onset due to cerebral embolism. This case also stands out because of its rare etiology. Streptoccocus thoraltensis, which was first described by Devriese et al in 1997, was isolated for the first time from human subgingival plaque by Dhotre et al in 2014. Both cardiac and neurologic complications appeared, underlying that infective endocarditis is a condition that requires an early diagnosis and a multidisciplinary team.