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

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

High grade fevers persisted, and antimicrobials including vancomycin 1 g every 12 h and cefepime 2 g every 8 h were resumed. Blood cultures remained negative. On the fourth day of admission, her mental status declined, associated with worsening headache. She exhibited hyperreflexia on examination, but no meningeal signs, papilledema, or focal neurological deficits. Given her coronavirus infection, hyperreflexia, and the development of confusion, computed tomography (CT) of the brain was performed. CT of the brain showed no acute pathology, however there was an incidental finding of a cystic structure extending from the right cerebello-pontine angle to the foramen magnum that precluded obtaining a lumbar puncture. Empiric treatment for meningitisencephalitis with broad-spectrum antimicrobials and antivirals was started, including vancomycin 1 g every 12 h, ceftriaxone 2 g every 12 h, ampicillin 2 g every 4 h, and acyclovir 700 mg every 8 h. Magnetic resonance imaging (MRI) of the brain was attempted to better evaluate the cystic lesion and to evaluate for a possible dural venous sinus thrombosis, but the patient developed acute respiratory distress and the study was not completed. Chest radiography demonstrated pulmonary edema and congestion. Trans-thoracic echocardiography (TTE) showed normal left ventricular function, normal ejection function, reduced respiratory variation of the inferior vena cava consistent with a volume overloaded state, posterior mitral leaflet prolapse, moderate thickening of the mitral valve leaflets, moderate mitral regurgitation, but no vegetation, as shown in Fig. 1a .