Delayed Diagnosis of Infective Endocarditis Complicated With Stroke

Infective endocarditis can complicate with ischemic stroke. Neurological complications develop in 20-40% of all patients with infective endocarditis. These are mainly due to vegetation embolism.This report represents a case of 30 years old female patient who presented with features of heart failure New York Heart Association (NYHA) class IV with infective endocarditis and left hemiparesis. On examination at admission, she was conscious, afebrile, orthopneic, tachypneic, had warm extremities, tinge of jaundice, finger and toe clubbing grade 4, and moderate pretibial edema. Her blood pressure was 107/54 mm Hg and had heart rate of 125 beats per minute. She had cardiomegaly with apex shifted to 6th intercostal space, soft s1 loud p2 and apical pansystolic murmur grade 3 radiating to axilla of MR, pansystolic murmur left lower sternal border of TR and early diastolic murmur of AR. There was mild ascites, hepatosplenomegaly, fine bilateral bibasal crepitations and left hemiparesis. Echocardiogram showed severe mitral regurgitation, moderate aortic regurgitation and multiple vegetations. This case is presented to assert the importance of early diagnosis of infective endocarditis to prevent the occurrence of neurological sequelae. The rapid diagnosis using Dukes criteria of infective endocarditis is of paramount importance to prevent or reduce neurological sequelae. This patient had findings of splenomegaly and clubbing suggesting long standing endocarditis that could have been identified early.