title: Infective endocarditis complicated with cerebral and splenic infarction in a hemodialysis patient.
abstract: BACKGROUND
  Infective endocarditis (IE) has a high risk of morbidity and mortality. Complications are often due to systemic embolization. We treated a 47-year-old hemodialysis man with infective endocarditis complicated with cerebral and splenic infarction.
  
  
  METHODS
  The patient was brought to the emergency department because of altered mental status and fecal incontinence. Although he did not meet the Duke Criteria for IE diagnosis, clinical suspicions of IE warranted further diagnostic studies. Magnetic resonance imaging of the brain revealed cerebral infarction with abnormal neurological findings. An abdominal computerized tomography revealed an incidental and unexpected splenic infarction without physical findings. Echocardiography revealed a vegetative growth (-1.2×1 cm) over the mitral posterior leaflet with severe mitral valve regurgitation. Based on these results, the patient was diagnosed with IE complicated with severe cerebral and splenic infarction.
  
  
  RESULTS
  The patient was treated with intravenous teicoplanin including gentamicin, subcutaneous low molecular weight heparin, and oral acetylsalicylic acid. Mitral valve replacement surgery was performed after the patient improved clinically.
  
  
  CONCLUSIONS
  Emergency physicians should be aware of the life-threatening complications of IE, which may be presented subtly or without clinical evidence.
authors.affiliation: Department of Emergency Medicine, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey.
authors.forename: Ozge Duman
authors.initials: OD
authors.lastname: Atilla
authors.affiliation: Department of Emergency Medicine, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Temizyurek
authors.affiliation: Department of Emergency Medicine, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey.
authors.forename: Egemen
authors.initials: E
authors.lastname: Kirman
keywords: Cerebral infarction; Infective endocarditis; Splenic infarction