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Case Report

Infective endocarditis with brain lesions

misdiagnosed as viral encephalitis

Jing-Jing Zhang, Guo-Dong Feng
Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, Shaanxi, China.

A B S T R AC T

Infective endocarditis (IE) is caused by infection of the endocardial surface of heart. It typically affects one or more heart valves,
the mural endocardium, or a septal defect. In recent years, many IE patients suffered from atypical initial symptoms. Here, in this
case report, a 12-year-old patient was initially diagnosed as encephalitis. However, it was later noticed that this was a misdiagnosis
for the following reasons: the echocardiography showed a vegetation attached to his mitral valves; the cranial magnetic resonance
imaging showed lesions that were consistent with a cardioembolic distribution. The final diagnosis was IE.

Key words: Antiplatelet agents, embolic events, infective endocarditis

INTRODUCTION from headache, along with nausea and vomiting.
Subsequently, he had an episode of generalised
Infective endocarditis (IE) is caused by infection tonic-clonic seizure. These symptoms lasted several
of endocardial surface of heart. It may affect one or minutes. Then he came to his senses, but with low
more heart valves, the mural endocardium or a septal weak voice and slow responses. His cranial magnetic
defect. Embolic events are serious complications, resonance imaging (MRI) was performed in the
[1]
and it is estimated that they occur in 10% to 50% in IE referring hospital. This revealed the presence of
patients. Embolic stroke is among the most notable multiple lesions in bilateral cerebellar hemisphere,
[2]
and life-threatening ones. It interferes with patient the right thalamus and occipital lobe. Cerebrospinal
normal activities and can cause death. However, fluid was acellular with normal protein and glucose.
[3]
as IE clinical symptoms have become atypical and He was diagnosed with viral encephalitis and
the morphology and location of embolic intracranial treated with intravenous acyclovir and mannitol. On
lesions are in diverse forms, it may easily lead to December 4, the patient suddenly developed a left
misdiagnosis. Here, we describe a case of cerebral limbs weakness. At that stage he was then transferred
[4]
embolism with atypical IE symptoms. to our clinic.
CASE REPORT In the physical examination, we observed that he
was having a heart murmur, slow response, low
The patient is a 12-year-old male without any previous weak voice, slow light reflex in left pupil and left
disease. On November 28, 2014, he got a fever with the hemiplegia. There were no meningeal signs. Routine
body temperature of 39.5 °C. He no longer had fever blood examination showed mild anemia (hemoglobin
after infusion. Three days later, he suddenly suffered 122 g/L, normal 130-175 g/L). Upon his admission, the
following laboratory tests gave a negative result: blood
Corresponding Author: Dr. Guo-Dong Feng, Department biochemistry analysis, coagulation profile, myocardial
of Neurology, Xijing Hospital, the Fourth Military Medical
University, No. 169 Changle West Road, Xi’an 710032, Shaanxi,
China. E-mail: fgd2000@163.com This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
Access this article online author is credited and the new creations are licensed under the identical terms.
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Cite this article as: Zhang JJ, Feng GD. Infective endocarditis with
brain lesions misdiagnosed as viral encephalitis. Neuroimmunol
DOI: Neuroinflammation 2016;3:48-50.
10.20517/2347-8659.2015.29
Received: 09-07-2015; Accepted: 01-10-2015

48 © 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc.