1123. Infective Endocarditis Diagnosed from Pathological Evaluation of Septic Embolus in Setting of Acute Stroke

Authors: Allison Elizabeth Strickland, MD; Bradley Bohnstedt, MD; Kyle O'Connor, BS (Oklahoma City, OK)

Introduction:

Embolic stroke is one of the major complications in infective endocarditis. Ischemic stroke occurs in 20-40% of patients with native-valve infective endocarditis of the mitral or aortic valve. Blood cultures and echocardiogram are the gold standard tests to diagnose infective endocarditis. We present a case of infective endocarditis diagnosed from pathological examination of the thrombus and blood cultures in the setting of acute stroke.

Methods:

A 62-year-old female with large vessel occlusion on aspirin and Coumadin with a history of bovine aortic valve replacement underwent thrombectomy of a left middle cerebral artery embolus. The patient had a remote hospital admission for osteomyelitis of the lumbar spine with blood cultures positive for Enterococcus faecalis. On previous admission, echocardiogram was negative for valvular vegetations and was within normal limits. The patient presented to our emergency department with aphasia and right sided weakness. The patient was evaluated by the stroke team and was not a tPA candidate due to an INR of 3. The patient was taken to the neurointervention suite for thrombectomy.

Results:

The patient had successful thrombectomy with TICI2b recanalization. Pathology for the embolus demonstrated blood clot composed of abundant bacterial colonies of almost 50%. Blood cultures from admission came back positive for Enterococcus faecalis and the patient was given intravenous antibiotics. Echocardiogram showed no valvular vegetations, but the patient was sent for cardiac catheterization due to pathology results from the thrombus. Cardiac catheterization demonstrated a prosthetic aortic heart valve with a valvular motion abnormality. The patient eventually died due to hypoxic respiratory failure complicated by COPD.

Conclusion:

Mechanical thrombectomy is a useful tool in patients with large vessel occlusion from different types of embolism. Careful follow-up of blood cultures and pathology results after thrombectomy is crucial in improving patient outcome and initiating early antibiotic therapy.