Haemophilus parainfluenzae endocarditis with multiple cerebral emboli in a pregnant woman with coronavirus

De Castro, Alicia; Abu-Hishmeh, Mohammad; El Husseini, Ibrahim; Paul, Lisa

On the fifth hospital day, blood cultures demonstrated gramnegative bacilli. Cultures from the outside hospital were reported positive for Haemophilus parainfluenzae. Her antimicrobial therapy was narrowed to ceftriaxone 2 g every 24 h. MRI of the brain ( Fig. 2a and b) showed multiple subcentimeter foci within the bilateral frontoparietal regions, left occipital lobe, and bilateral cerebellar hemispheres consistent with septic emboli and thromboembolic infarcts. A trans-esophageal echocardiogram (TEE) was recommended, however the patient refused given the risk of vocal cord injury on intubation. A repeat TTE on day 10 (Fig. 1b) then revealed a vegetation on the mitral valve measuring 1.4 Â 1.3 Â 0.8 cm. Given her multiple cranial emboli and the presence of a large vegetation after embolization, the patient was deemed high risk for further embolic complications. The patient then underwent emergent Caesarian delivery followed by mitral valve repair. Intra-operative findings included large friable vegetations on the mitral valve and a thrombous on the posterolateral papillary muscle. Her post-operative course was uncomplicated. She remained afebrile and her clinical status improved, with normal mentation and normal cardiopulmonary function. She was discharged home to complete a four-week course of intravenous ceftriaxone.