Infective Endocarditis Complicated with Cerebral Infarction and Osler's Nodes

A 25-year-old man had a 6-year history of rheumatic heart disease with mitral regurgitation. He had experienced persistent reddish and painful Osler’s nodes on the fingertips for 2 months. One week before admission, he developed an acute onset of slurred speech. Physical examination showed a grade V/VI pansystolic murmur at the cardiac apex with transmission to the left axillary region. Blood cultures revealed Streptococcus viridans infection. Echocardiography showed a vegetative growth over the mitral leaflet of about 1.0×0.5 cm, with severe mitral valve regurgitation. Magnetic resonance imaging of the patient’s brain revealed multiple lesions scattered primarily in the cortical layers of both cerebral hemispheres and cerebellum, with a bright signal intensity on diffusion-weighted and contrast-enhanced T1-weighted images. A diagnosis was made of infective endocarditis with cerebral infarction and Osler’s nodes. Emergency cardiotomy, debridement, and mitral valve replacement were performed. After surgery, he received anticoagulation therapy (5 mg/day coumadin) and intravenous penicillin G (24 million units per day) for 6 weeks, and recovered without sequelae.

並列關鍵字

cerebral infarction ； infective endocarditis ； Osler's node ； Streptococcus viridans

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