American Journal of Pediatrics

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A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis

Received: Oct. 06, 2019    Accepted: Nov. 04, 2019    Published: Nov. 25, 2019
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Abstract

The mortality rate associated with cerebral hemorrhage as a complication of IE is extremely high despite the development of preventive and antibiotic therapy. We report a 13-year-old female whose previous medical history includes Jeune syndrome and mitral regurgitation. She was taken to a nearby hospital because of high body temperature. She had no symptoms of cold or gastrointestinal disturbance and was diagnosed with upper respiratory tract inflammation. On the subsequent day, she experienced a seizure and was brought to the emergency department of the general hospital. Her head computed tomography (CT) revealed bleeding and mild cerebral edema in the left occipital lobe. A mild systolic murmur was audible upon auscultation. She presented with carious tooth and Janeway lesions. Methicillin-resistant Staphylococcus aureus (MRSA) was positive on blood culture examination, cerebrospinal fluid examination was negative. A diagnosis of IE was established based on the Duke criteria. Antibiotic therapy was administered. Thereafter, the symptoms disappeared without any adverse effects, and antibiotic administration was ended in six weeks. After the discharge, dental treatment was initiated. There was no recurrence of IE at 3 years after the onset, and no sequelae were observed. Although the prevalence of cerebral hemorrhage as a complication of IE is low, the associated mortality rate is extremely high despite the development of preventive and antibiotic therapy. Moreover, there is no consensus regarding the treatment method. In this case, only a conservative treatment was performed without sequelae. Pediatric patients with stroke associated with IE may have better outcome than adults. It is important to suspect IE and to provide immediate or early treatment if fever and central nervous symptoms are observed in cases with underlying heart disease.

DOI 10.11648/j.ajp.20190504.27
Published in American Journal of Pediatrics ( Volume 5, Issue 4, December 2019 )
Page(s) 267-269
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Cerebral Hemorrhage, Infective Endocarditis, Children

References
[1] Thuny F, Avierinos JF, Tribouilloy, et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study. Eur Heart J. 2007; 28: 1155–1161.
[2] Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009; 169: 463-473.
[3] Duval X, Delahaye F, Tattevin P, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol. 2012; 59: 1968-1976.
[4] Lawrence L, Pelletier Jr, and Petersdorg R. Infective Endocarditis: A review of 125 cases from the University of Washington Hospitals. Medicine. 1977; 56: 1963-1972.
[5] Duranate-Mangoni E, Bradley S, Selton-Suty C, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med 2008; 168: 2095-2103.
[6] Keiko M, Katsumi A, Kei N et al, The two cases of infective endocarditis complicated rupture of bacterial aneurysm. Heart, 1986; 18: 210-217.
[7] Okazaki S, Yoshioka D, Sakaguchi m, et al. Acute ischemic brain lesions in infective endocarditis: incidence, related factors, and postoperative outocome. Cerebrovase Dis. 2013; 35: 155-162.
[8] Charu V, Mark S. P. Pediatric Endocarditis and Stroku: A single Center Retrospective Review of Seven Cases. Pediatr Neurol. 2008; 38: 243-247.
[9] Gui-fang Cao, Qi, Pediatric and stroke: A 13-year single center review. Pediatr Neurol. 2019; 90: 56–60.
[10] Christopher E, Dimitrios N, Ali S, et al, HydroCoil embolization of a ruptured aneurysm in a pediatric patient: case report and review of the literature. Childs Nerv Syst. 2007; 23: 707–712.
[11] Filipa F L, Lurdes L, Antonio S, et al, Myotic brain aneurysm and cerebral hemorrhagic stroke: a pediatric case report. Eur J pediatr, 2013; 172: 1285-1286.
[12] Salagado AV, Furlan AJ, Keys TF, et al. Neurologic complications of endocarditis: a 12-year single-center experience. Neurology. 1989; 39: 173-178.
[13] Chen CH, Lo MC, Hwang KL, et al. Infective endocarditis with neurologic complications: 10-year experience. J Microbiol Immunol Infect. 2001; 34: 119-124.
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  • APA Style

    Keishiro Furuie, Hiroshi Tamura, Osamu Matsuo, Hiroshi Mitsubuchi. (2019). A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis. American Journal of Pediatrics, 5(4), 267-269. https://doi.org/10.11648/j.ajp.20190504.27

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    ACS Style

    Keishiro Furuie; Hiroshi Tamura; Osamu Matsuo; Hiroshi Mitsubuchi. A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis. Am. J. Pediatr. 2019, 5(4), 267-269. doi: 10.11648/j.ajp.20190504.27

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    AMA Style

    Keishiro Furuie, Hiroshi Tamura, Osamu Matsuo, Hiroshi Mitsubuchi. A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis. Am J Pediatr. 2019;5(4):267-269. doi: 10.11648/j.ajp.20190504.27

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  • @article{10.11648/j.ajp.20190504.27,
      author = {Keishiro Furuie and Hiroshi Tamura and Osamu Matsuo and Hiroshi Mitsubuchi},
      title = {A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {4},
      pages = {267-269},
      doi = {10.11648/j.ajp.20190504.27},
      url = {https://doi.org/10.11648/j.ajp.20190504.27},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20190504.27},
      abstract = {The mortality rate associated with cerebral hemorrhage as a complication of IE is extremely high despite the development of preventive and antibiotic therapy. We report a 13-year-old female whose previous medical history includes Jeune syndrome and mitral regurgitation. She was taken to a nearby hospital because of high body temperature. She had no symptoms of cold or gastrointestinal disturbance and was diagnosed with upper respiratory tract inflammation. On the subsequent day, she experienced a seizure and was brought to the emergency department of the general hospital. Her head computed tomography (CT) revealed bleeding and mild cerebral edema in the left occipital lobe. A mild systolic murmur was audible upon auscultation. She presented with carious tooth and Janeway lesions. Methicillin-resistant Staphylococcus aureus (MRSA) was positive on blood culture examination, cerebrospinal fluid examination was negative. A diagnosis of IE was established based on the Duke criteria. Antibiotic therapy was administered. Thereafter, the symptoms disappeared without any adverse effects, and antibiotic administration was ended in six weeks. After the discharge, dental treatment was initiated. There was no recurrence of IE at 3 years after the onset, and no sequelae were observed. Although the prevalence of cerebral hemorrhage as a complication of IE is low, the associated mortality rate is extremely high despite the development of preventive and antibiotic therapy. Moreover, there is no consensus regarding the treatment method. In this case, only a conservative treatment was performed without sequelae. Pediatric patients with stroke associated with IE may have better outcome than adults. It is important to suspect IE and to provide immediate or early treatment if fever and central nervous symptoms are observed in cases with underlying heart disease.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis
    AU  - Keishiro Furuie
    AU  - Hiroshi Tamura
    AU  - Osamu Matsuo
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    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 267
    EP  - 269
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20190504.27
    AB  - The mortality rate associated with cerebral hemorrhage as a complication of IE is extremely high despite the development of preventive and antibiotic therapy. We report a 13-year-old female whose previous medical history includes Jeune syndrome and mitral regurgitation. She was taken to a nearby hospital because of high body temperature. She had no symptoms of cold or gastrointestinal disturbance and was diagnosed with upper respiratory tract inflammation. On the subsequent day, she experienced a seizure and was brought to the emergency department of the general hospital. Her head computed tomography (CT) revealed bleeding and mild cerebral edema in the left occipital lobe. A mild systolic murmur was audible upon auscultation. She presented with carious tooth and Janeway lesions. Methicillin-resistant Staphylococcus aureus (MRSA) was positive on blood culture examination, cerebrospinal fluid examination was negative. A diagnosis of IE was established based on the Duke criteria. Antibiotic therapy was administered. Thereafter, the symptoms disappeared without any adverse effects, and antibiotic administration was ended in six weeks. After the discharge, dental treatment was initiated. There was no recurrence of IE at 3 years after the onset, and no sequelae were observed. Although the prevalence of cerebral hemorrhage as a complication of IE is low, the associated mortality rate is extremely high despite the development of preventive and antibiotic therapy. Moreover, there is no consensus regarding the treatment method. In this case, only a conservative treatment was performed without sequelae. Pediatric patients with stroke associated with IE may have better outcome than adults. It is important to suspect IE and to provide immediate or early treatment if fever and central nervous symptoms are observed in cases with underlying heart disease.
    VL  - 5
    IS  - 4
    ER  - 

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Author Information
  • Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

  • Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

  • Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

  • Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

  • Section