以腦出血表現之感染性心內膜炎合併梗塞性腦中風之病例報告

Infective Endocarditis Presented with Intracranial Hemorrhage Followed by Ischemic Stroke: A Case Report

本案例為一位60歲男性，無特殊心臟病史，最近在接受牙周治療之後開始發燒，因左側肢體無力而住院治療，腦部電腦斷層顯示腦出血及蜘 蛛膜下腔出血，住院期間除發燒及左側肢體無力外，其他臨床表徵並不明顯。檢查數據呈現白血球偏高及C-反應蛋白指數升高，血液培養報告 為草綠色鏈球菌，心臟超音波發現二尖瓣有贅生物，據此可確診為感染性心內膜炎，同時合併腦 出血之併發症。治療期間又併發梗塞性腦中風，因此懷疑該疾病並未充分治療，故延長抗生素治療療程，再度血液培養呈現陰性，病情穩定後順利出院。感染性心內膜炎初期臨床表徵不明顯，若中風病人合併發燒，又有危險因子存在時，應將此疾病列入鑑別診斷。影像學顯示腦出血合併蜘蛛膜下腔出血，並非典型高血壓性腦出血的表現，也是高度懷疑此疾病的線索之一，而血液培養結果可協助抗生素的選用。

 

This case report shared the experience of taking care of a 60-year-old man, who suffered from fever after receiving periodontal therapy. He was admitted because of acute left limbs weakness. The brain computed tomography (CT) showed intracerebral hemorrhage with subarachnoid hemorrhage. The laboratory data showed leukocytosis and elevated C-reactive protein (CRP) level. Blood culture yielded Viridans streptococcus. Echocardiography found a vegetation on the mitral valve. Based on the Duke criteria, he was diagnosed with infective endocarditis (IE). We extended the antibiotic treatment because the patient was complicated with acute ischemic stroke. His clinical condition eventually improved, and the following blood culture became negative. He was discharged smoothly. The clinical manifestations of IE in this case was not obvious incipiently. IE should be a differential diagnosis in stroke patients who develop a fever, in particular for those with risk factors for IE. In addition, the pattern of intracranial hemorrhage in brain CT could provide clues to the diagnosis of IE and the result of blood cultures could assist in the selection of antibiotics.