A CLINICAL CASE OF INFECTIVE ENDOCARDITIS COMPLICATED BY MENINGOENCEPHALITIS
Authors:   Kazan State Medical University, KHAMITOV RUSTEM F. , SATTAROVA FIRYUZA I. ,   Kursk State Medical University
Published: January 2025

Abstract. Introduction. Infective endocarditis is an infectious and inflammatory disease of the cardiovascular system
with damage to the valvular structures of endocardium, artificial valves or parietal endocardium with the development
of polyposis and ulcerative changes in the damaged heart structures and destruction of their functions. Injection
drug users are at risk of developing infective endocarditis. Among them, the incidence ranges from 2 to 5% per year.
Complications of infective endocarditis often include heart failure, pneumonia, and damage to the nervous system
(mainly acute cerebrovascular accident). The prevalence of meningitis and meningoencephalitis in infective endocarditis
is approximately 3%. Aim. Using a clinical example, analyze the features of infective endocarditis complicated by
meningoencephalitis. Materials and Methods. Review of international and national publications in the PubMed and
eLibrary databases regarding the infective endocarditis developing complications. A clinical case of infective endocarditis associated with intravenous administration of drugs, manifested as acute cerebrovascular accident complicated by
secondary meningoencephalitis. Results and Discussion. This paper considers the case of a 20-year-old female
patient with infective endocarditis associated with intravenous drug use. The disease debuted with acute cerebrovascular
accidents of cardioembolic origin. During hospitalization, she received statins, rivaroxaban and acetylsalicylic acid,
cefazolin, metronidazole, and levofloxacin. She was discharged with partial regression of neurological formations. The
temperature held up within the range of 37.5 to 38.5 °C. The patient followed the recommendations partially (she only
took statins). 2 weeks after discharge, there were episodic increases in her body temperature up to 40°C appeared,
and her general weakness progressed. She was forced to go to the hospital emergency room. The data identified, such
as three times vomiting, severe pain in the right extremities, periodic convulsive twitching in the extremities, speech
impairment, stiff neck muscles by 4 transverse fingers, positive upper and lower Brudzinski signs, and increased
sensitivity to light and loud sounds, updated the diagnostic search for meningoencephalitis. During diagnosing, the results
of cerebrospinal fluid culture verified secondary meningoencephalitis caused by Staphylococcus haemolyticus. The
patient received linezolid and vancomycin for 14 days. She was discharged with improvement in form of the neurological
syndrome regression. It is recommended to continue outpatient treatment with linezolid for up to 1 month and follow
up with a cardiac surgeon. Conclusions. The clinical case presented demonstrates the importance of multidisciplinary
examination of patients with IE for the timely detection of extracardiac complications and clarification of indications for
invasive diagnostics, including in form of lumbar puncture with cerebrospinal fluid culture. This approach contributes to
a timely selection of adequate therapy and determines the outcome of the disease.