Isolated Disturbance of Consciousness as Initial Presentation of Staphylococcus aureus Endocarditis: A Case Report With Brief Literature Review.
Weixiong Zhong, Shanshan Huang, Jing Jiang et al.
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Case in brief
A man in his 50s presented with isolated disturbance of consciousness and no reported fever, although his admission temperature was 38°C. Brain imaging showed an extensive acute right hemispheric watershed infarction without hemorrhage. Further investigation found Staphylococcus aureus bacteremia, mitral valve vegetation, and multiple organ dysfunction syndrome, establishing infective endocarditis. The absence of classic endocarditis risk factors contributed to delayed diagnosis. Guideline-concordant management was provided; long-term outcome was unavailable after transfer, but in-hospital mortality after transfer was confirmed.
What made this case unusual
Disturbance of consciousness was the predominant initial manifestation, without a reported history of fever or classic endocarditis risk factors, despite underlying S. aureus endocarditis and acute cerebral infarction.
Diagnostic / clinical pearl
In a patient with sepsis and acute cerebral infarction presenting with disturbed consciousness, include infective endocarditis in the differential even when classic risk factors or a typical presentation are absent.