A 69-year-old man presented with acute deterioration of consciousness and tetraparesis. Bacterial endocarditis following mitral valve reconstruction was established 4 weeks prior to the onset of his neurologic deficits. The initial clinical suspicion was of an embolic brainstem infarction. CCT, however, demonstrated multiple intracerebral convoluted tubular hypodensities (figure), most likely representing intra-arterial gas accumulation as a result of multiple septic emboli from bacterial endocarditis. Repeated blood cultures confirmed Lactobacillus rhamnosus, an anaerobic Gram-positive bacillus. The patient died 2 days later despite extensive antibiotic and antimycotic treatment. In addition to bacterial meningoencephalitis further septic emboli leading to infarction of spleen and kidney were identified at autopsy.
Figure CT scan showing multiple intracerebral hypodensities most likely representing intra-arterial gas as a result of septic emboli due to Lactobacillus rhamnosus
Footnotes
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Disclosure: The authors report no conflicts of interest.
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