Lactococcus garvieae endocarditis presenting with subdural haematoma.
BACKGROUND
Lactococcus garvieae is a rare cause of infective endocarditis (IE) in humans and the bacterium can easily be misidentified. Intracranial haemorrhage often occurs in conjunction with IE, but subdural haemorrhage (SDH) is very rarely encountered.


METHODS
The patient was an 81-year-old male with a history of cardiovascular disease and a prosthetic biologic aortic valve. He presented with fatigue and an acute onset of headache. Computed tomography (CT) revealed a left-sided fronto-temporal subdural haematoma. Low-grade fever was noted and blood cultures yielded growth of L. garvieae. Transesophageal echocardiography (TEE) revealed small vegetations on the native mitral valve and on the prosthetic aortic valve. Treatment with penicillin and tobramycin was initiated and the recovery was slow but uneventful.


CONCLUSIONS
This is the first report of a case where SDH was the sole presenting neurological sign of IE. The case demonstrates that IE should be considered in patients with SDH where a history of trauma is absent, especially if the patient has fever or predisposing conditions such as a prosthetic heart valve.
Division of Infection Medicine, Lund University, From the Department of Clinical Sciences, BMC, B14, Tornavägen 10, Lund 22184, Sweden. Magnus.Rasmussen@med.lu.se.
Magnus
M
Rasmussen
Josefin
J
Björk Werner
Mikaela
M
Dolk
Bertil
B
Christensson
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000382:microbiology*; D006801:Humans; D017045:Lactococcus / Q000302:isolation & purification*; D008279:Magnetic Resonance Imaging; D008297:Male; D010406:Penicillins / Q000627:therapeutic use; D013997:Time Factors; D014031:Tobramycin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins; D014031:Tobramycin