OBJECTIVE
Incidence rate of infective endocarditis (IE) is approximately 3 to 9 cases per 100.000 children per year. In this case, we report meningoencephalitis as an early and rare neurological extra cardiac complication of IE which occurs in every 2 to 20% of cases and associated with higher mortality.
CASE PRESENTATION
An eight year-old boy presented with fever and decreased consciousness. Neurological examination revealed positive meningeal sign. Cerebrospinal fluid
(CSF) analysis showed pleocytosis with dominant polymorphonuclear cells, high protein level, low glucose level and positive Pandy’s test. He was diagnosed with
meningoencephalitis and treated with Ceftriaxone. Both CSF and two separate blood cultures revealed Staphylococcus aureus (S. aureus) growth. On the fifteenth day of hospitalization, systolic murmur was heard at the apex, that was later confirmed by echocardiography as vegetation in the mitral leaflet and severe mitral regurgitation. IE was established based on Modified Duke Criteria which were positive blood culture of S. aureus from two separate blood cultures and endocardial involvement proven by echocardiography. Antibiotic was changed to Cefazolin, and given for four weeks whereas Gentamicin was only given for seven days, along with anticongestive treatment. Valvuloplasty was planned to avoid progressive heart failure and irreversible structural damage.
CONCLUSION
Meningoencephalitis can appear as an early manifestation of IE hence monitoring of the heart murmur as the most common cardiac sign is mandatory to establish the diagnosis and define antibiotic duration.