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  • Challenges of remote consultations: a delayed diagnosis of aortic valve endocarditis complicated by recurrent intracranial events

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Case Reports: Reminder of important clinical lesson
Challenges of remote consultations: a delayed diagnosis of aortic valve endocarditis complicated by recurrent intracranial events
  1. Polyvios Demetriades1,
  2. Paul Ridley2,
  3. Farah Yazdani3 and
  4. Simon Duckett1
  1. 1Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  2. 2Cardiothoracic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  3. 3Microbiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  1. Correspondence to Dr Polyvios Demetriades; polyvios.demetriades{at}nhs.net

Abstract

Embolic events causing stroke and intracranial haemorrhage are among the most catastrophic complications of infective endocarditis (IE).

A female patient presented with acute unilateral weakness following a 3-month history of fever, for which she had multiple remote consultations with her general practitioner. A brain MRI confirmed a left sided infarct with haemorrhagic transformation. Blood cultures grew Streptococcus mitis and her cardiac imaging showed an aortic valve vegetation with severe aortic regurgitation. Following 2 weeks of antibiotics she developed a new cerebral haemorrhage associated with a mycotic aneurysm which was treated with two coils. After discussions within the multidisciplinary meeting, she underwent aortic valve replacement 3 weeks later. She made a remarkable recovery and was discharged.

Our case highlights the importance of face-to-face clinical review in the post-COVID era. It stresses that the management of patients with infective endocarditis and neurological complications is challenging and requires a multidisciplinary approach.

  • valvar diseases
  • stroke
  • cardiothoracic surgery
  • general practice / family medicine

https://doi.org/10.1136/bcr-2021-248287

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    Footnotes

    • Contributors PD has been involved in the medical management of the patient during her inpatient stay. He was involved in the investigations (TTE, TOE). He has written the manuscript and he is the corresponding author. PR was the cardiothoracic surgeon who was involved in the patient’s management and performed the operation. He has provided a review of the manuscript. FY is the microbiologist who was involved in the patient’s management and has reviewed the manuscript. SD was the responsible clinician in charge of the care of the patient and has written parts of the manuscript and has reviewed the remaining.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.