Fatal Streptococcus agalactiae endocarditis complicated by basal ganglia hemorrhage and multiple cerebral infarcts: A case report

Streptococcus agalactiae is an uncommon cause of infective endocarditis in adults but is associated with aggressive disease and a high risk of systemic embolization. Neurological complications significantly contribute to morbidity and mortality. We report a 47-year-old woman who presented with fever and right-sided weakness. Clinical examination revealed an apical pansystolic murmur. Cranial computed tomography demonstrated a right basal ganglia hematoma. Transthoracic echocardiography showed a large mobile vegetation on the anterior mitral leaflet with severe mitral regurgitation. Blood cultures grew pan-sensitive Streptococcus agalactiae . On the second hospital day, the patient developed seizures and altered sensorium requiring endotracheal intubation. Magnetic resonance imaging of the brain revealed multiple acute embolic infarcts in both supratentorial and infratentorial regions. Cardiac surgery was recommended due to the large vegetation and severe valvular dysfunction; however, the family opted for conservative management. This case is unique as it demonstrates native mitral valve S. agalactiae infective endocarditis presenting with both intracranial hemorrhage of undetermined etiology and multiple embolic infarcts. To the best of our knowledge, such a combination has not been previously reported.