A Complex Case of Infective Endocarditis With Systemic Embolization: Multidisciplinary Approach to Diagnosis and Management

A 44-year-old man with no known medical history presented with stroke symptoms and was found to have occlusion of the M1 segment of the right middle cerebral artery. Thrombolysis and aspiration thrombectomy were successfully performed. However, in the following hours, he developed a fever and multiple cerebral hemorrhages. Due to a drop in hemoglobin post-angiography, an abdominopelvic CT was performed, revealing extensive splenic and renal infarctions. The patient was diagnosed with infective endocarditis (IE) with mitral and aortic vegetations and severe aortic regurgitation. Treatment for IE was initiated, and valve surgery was scheduled after six weeks of antibiotic therapy. Transesophageal echocardiogram documented pseudoaneurysm of the anterior mitral valve leaflet with a high risk of rupture, leading to the decision for early surgery. A prior splenectomy was performed due to the risk of splenic bleeding during anticoagulation for cardiac surgery, being complicated by hemorrhagic shock. The patient ultimately died from complications, including ventilator-associated pneumonia, septic shock, and refractory respiratory failure. Stroke can be the initial manifestation of IE, and the optimal medical and surgical approach must consider the risks of systemic embolization and surgical complications.