title: Cerebral hemorrhage in infective endocarditis caused by Actinobacillus actinomycetemcomitans.
abstract: Cerebral hemorrhage occurs rarely in endocarditis caused by Actinobacillus actinomycetemcomitans. A 51-year-old man with a prosthetic mitral valve, who had been prophylactically treated (7 years) with warfarin, presented with intermittent fever. On admission, a Levine grade II/VI systolic cardiac murmur was detected. A transthoracic echocardiogram was negative for valve vegetation. Cefepime (1 g every 8 hours) was administered intravenously. On day 4, culturing of Gram-negative bacilli from blood and a transesophageal echocardiogram revealed a small oscillating filament attached to lateral mitral prosthetic ring on the atrial side. Ceftriaxone (2 g once daily) was started. Gait instability and left-side weakness developed abruptly 2 weeks later; brain magnetic resonance imaging revealed a hematoma over the right parietal-occipital lobe. Ceftriaxone was adjusted to 2 g every 12 hours. Actinobacillus actinomycetemcomitans was identified 3 weeks later. Recovery was achieved, with significant interval improvement and resolution of the cerebral lesions evident on CT.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Gen-Min
authors.initials: GM
authors.lastname: Lin
authors.forename: Kai-Min
authors.initials: KM
authors.lastname: Chu
authors.forename: Chun-Jung
authors.initials: CJ
authors.lastname: Juan
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
mesh_terms: D000189:Actinobacillus Infections / Q000150:complications* / Q000188:drug therapy; D016976:Aggregatibacter actinomycetemcomitans / Q000472:pathogenicity*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects; D002443:Ceftriaxone / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000382:microbiology* / Q000473:pathology; D004696:Endocarditis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014859:Warfarin; D002443:Ceftriaxone