Abstract
Echocardiographic examination is useful in diagnosis of infective endocarditis, with transesophageal echocardiography (TEE) being more accurate than transthoracic echocardiography. However there are few reports how vegetation changes successively in TEE observation. And central nervous system involvement in conjunction with infective endocarditis typically emerges from septic embolism. The case we described suggests that observation of vegetation with TEE informs us the beginning of cerebral infarction. A 77-year-old woman with a history of third degree burn and diabetes mellitus was admitted to ICU with persistent fever, shortness of breath, and pneumonia. Transthoracic echocardiography detected no vegetation. On the second ICU day, blood culture was positive for methicillin resistant Staphylococcus aureus (MRSA). And on the third ICU day, TEE revealed oscillating mass on the mitral valve, and infective endocarditis was defined according to the Duke’s criteria. Head CT scan showed cerebral infarction. On the sixth ICU, TEE showed significant changes in vegetation size before and after sudden pupil dilation. TEE could demonstrate the cause of pupil dilation in this endocarditis patient without CT observation.
