BRIEF REPORT

Neisseria sicca Endocarditis Presenting as Multiple Embolic Brain Infarcts Christine Kirlew,1,a Kobina Wilmot,2 and Jorge L. Salinas3 1

Department of Internal Medicine, 2Department of Internal Medicine, Division of Cardiology, and 3Department of Internal Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia

A 58 year old male presented with a 14 day history of progressive forgetfulness and aggressiveness. He had a history of human immunodeficiency virus infection, ischemic cardiomyopathy, and a myxomatous mitral valve (status post Saint Jude’s mitral valve replacement 8 years before presentation). International normalized ratio was supra-therapeatutic on admission. A non-contrast computed tomography of the brain indicated multiple infarcts with hemorrhagic conversion. The source was later found to be a rare case of Neisseria sicca endocarditis. Keywords. peautic INR.

endocarditis; HIV; Neisseria sicca; suprathera-

The patient was a 58-year-old man who presented with a 14-day history of progressive forgetfulness and aggressiveness. The patient had a history of human immunodeficiency virus infection (CD4 191, 22%; viral load 90% of cases present with embolic events [3]. Current endocarditis guidelines recommend surgery in cases of prior embolism and large remaining vegetation [4]. In this case, the patient had already experienced embolic events, but the remaining vegetations

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BRIEF REPORT

1. Aronson PL, Nelson KA, Mercer-Rosa L, Donoghue A. Neisseria sicca endocarditis requiring mitral valve replacement in a previously healthy adolescent. Pediatr Emerg Care 2011; 27:959–62. 2. Balaj C, Ottenin MA, Henrion D, Beguinot I, et al. Native-valve tricuspid endocarditis due to Neisseria sicca with bilateral pulmonary embolism. Diagn Interv Imaging 2013; 94:1153–5. 3. Sommerstein R, Ramsay D, Dubuis O, et al. Fatal Neisseria sicca endocarditis. Infection 2013; 41:747–9. 4. American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease), Society of Cardiovascular Anesthesiologists et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48:e1. 5. Cinà CS, Arena GO, Fiture AO, et al. Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review. J Vasc Surg 2001; 33:861–7.

Neisseria sicca Endocarditis Presenting as Multiple Embolic Brain Infarcts.

A 58 year old male presented with a 14 day history of progressive forgetfulness and aggressiveness. He had a history of human immunodeficiency virus i...
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