DOI: 10.36347/sasjm.2020.v06i11.002

Pages: 216-219

A 19-year-old male patient with history of recurrent untreated episodes of tonsillitis and acute rheumatic fever treated with benzathin benzylpenicillin presented to the hospital with high fever and diastolic murmur at the 3rd left intercostal space. Transthoracic and transesophageal echocardiography revealed vegetations on the aortic valve with severe aortic regurgitation. Three blood cultures were positive for Streptococcus Sinensis. Although antimicrobial therapy with a 3rd generation cephalosporin and aminoglycoside was effective for controlling infection, patient developed on the 13th day of hospitalisation headache and right leg intermittent claudication. Cerebral MRI showed right parietal lobe aneurysm with occipital microbleeds. A thrombosed aneurysm of 3,5*1,2 cm was shown to be present in the right tibialis posterior artery. Abdominal ultrasound and CT scan showed hepato-splenomegaly without any signs of embolism or infarction. This case confirms that infective endocarditis may present with various life-threatening clinical situations. Clinicians should be aware that aortic valve vegetation induces generalized multi-organ embolism in the setting of IE in order to ensure prompt recognition and treatment of this fatal complication.