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Open Access Highly Accessed Case report

Lactococcus garvieae endocarditis presenting with subdural haematoma

Magnus Rasmussen*, Josefin Björk Werner, Mikaela Dolk and Bertil Christensson

Author Affiliations

Division of Infection Medicine, Lund University, From the Department of Clinical Sciences, BMC, B14, Tornavägen 10, Lund 22184, Sweden

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BMC Cardiovascular Disorders 2014, 14:13  doi:10.1186/1471-2261-14-13

Published: 1 February 2014

Abstract

Background

Lactococcus garvieae is a rare cause of infective endocarditis (IE) in humans and the bacterium can easily be misidentified. Intracranial haemorrhage often occurs in conjunction with IE, but subdural haemorrhage (SDH) is very rarely encountered.

Case presentation

The patient was an 81-year-old male with a history of cardiovascular disease and a prosthetic biologic aortic valve. He presented with fatigue and an acute onset of headache. Computed tomography (CT) revealed a left-sided fronto-temporal subdural haematoma. Low-grade fever was noted and blood cultures yielded growth of L. garvieae. Transesophageal echocardiography (TEE) revealed small vegetations on the native mitral valve and on the prosthetic aortic valve. Treatment with penicillin and tobramycin was initiated and the recovery was slow but uneventful.

Conclusion

This is the first report of a case where SDH was the sole presenting neurological sign of IE. The case demonstrates that IE should be considered in patients with SDH where a history of trauma is absent, especially if the patient has fever or predisposing conditions such as a prosthetic heart valve.

Keywords:
Infective endocarditis; Lactococcus garvieae; Subdural haematoma