Severe meningitis and infectious aneurysm rupture of the middle cerebral artery following mechanical thrombectomy in infective endocarditis: A case report

Introduction: Infective endocarditis (IE) is known to precipitate several severe complications, often culminating in dire outcomes. In this report, we present the case of a 33-year-old female with IE, which was further complicated by the occurrence of brain infarction, meningitis, and infectious aneurysm. Case report: A 33-year-old female patient, presenting with left limb weakness persisting for a duration of 15 h, was admitted to our medical facility. A head MRI scan disclosed the presence of an acute cerebral infarction located in the left hemisphere, and subsequent CT angiography confirmed an occlusion of the M1 segment of the left middle cerebral artery. Consequently, the patient underwent mechanical thrombectomy as an intervention. Several days later, echocardiography revealed the presence of a 6.5 x 3.2 mm vegetation on the anterior mitral valve cusp, while blood cultures returned positive for Streptococcus mitis. A diagnosis of IE was established, and antibiotic therapy tailored to the microbiological sensitivities was promptly initiated. However, on the ninth day of her hospitalization, the patient's clinical condition deteriorated significantly due to the emergence of critical complications, including meningitis and a infectious aneurysm. Despite the implementation of aggressive antibiotic therapy, her condition continued to worsen, ultimately resulting in her demise on the sixteenth day of hospitalization, precipitated by the rupture of the infectious aneurysm. Conclusions: The occurrence of infective endocarditis alongside brain infarction, meningitis, and infectious aneurysm in a single patient represents a rare, intricate, and gravely serious clinical scenario. In such instances, the responsibility for management should be vested in a multidisciplinary team of healthcare professionals.