ARE YOU CEREUS? AN ATYPICAL PRESENTATION OF BACILLUS CEREUS: ENDOCARDITIS COMPLICATED BY STROKE Luay Naji, Syed Hussain, Alice Zhang; The University of Queensland-Ochsner Clinical School, New Orleans, LA.
Introduction: Bacillus cereus, a gram-positive rod that infects via toxin-releasing spores, is often implicated in gastrointestinal illnesses. An atypical presentation of B. cereus is infective endocarditis. We report a case of B. cereus endocarditis complicated by stroke and a brief discussion of risk factors that could have played a role in this development. Case: A 59-year-old male was found surrounded by beer cans following a witnessed fall. Physical exam noted altered mental status and right sided facial droop with hemiparesis. The patient was in A-fib with RVR upon arrival to the tertiary hospital. The patient’s NIH stroke scale was 24 and a subsequent MRI revealed an evolving large left MCA infarction with hemorrhagic conversion. Post-hospital transfer, urgent thrombectomy of the left ICA was organized. During hospitalization, the patient developed leukocytosis with a fever of 102 F. Blood cultures initially showed no growth but repeat cultures grew Bacillus cereus. The discovery of bacteremia prompted a transesophageal Echo which highlighted
a thickened mitral valve with possible vegetations. Further investigation with chest, abdomen and pelvis imaging did not reveal a nidus for infection. The patient was subsequently started on vancomycin and rifampin which stabilized the WBC to normal range, yet the bacteremia persisted. The patient showed poor recovery from his stroke and was discharged to a SNF with plans to continue his antibiotics for 6 weeks. Blood cultures were finally clear of B. cereus more than 3 weeks after initial admission. Discussion: This case highlights a rare presentation of B. cereus bacteremia secondary to endocarditis. Our patient’s urine drug screen was only positive for THC and there was no documented history of prosthetic devices or IV drug use. A 2018 review noted 26 recorded cases of B. cereus endocarditis but only 3 patients had no risk factors. Although our patient’s history is limited due to the severity of his stroke, this case highlights the importance of considering a broad workup when patients present with B. cereus bacteremia without typical GI symptoms.
POSTER PRESENTATIONS – STUDENTS A CASE OF CRYPTOCOCCAL MENINGOENCEPHALITIS IN AN IMMUNOCOMPETENT PATIENT WITH CHIARI I MALFORMATION Shreya Gunda, Victoria Silver, Kimiknu Mentore, Lauren Nunez; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Over 90% of cases of cryptococcal meningoencephalitis present in immunocompromised patients, with the majority of those being in patients with AIDS. However, this infection can also occur in patients with other immunocompromised states, such as steroid use, malignancy, rheumatologic diseases, and use of immunosuppressive medications. Delay in diagnosis can often lead to rapid neurological deterioration and mortality. Case: A young immunocompetent patient, with a history of Chiari I malformation and recent COVID-19 infection presented with syncope following two weeks of headaches, generalized body aches and weakness after COVID-19 diagnosis. Physical exam demonstrated an isolated CN VI palsy. Neuro imaging revealed new right caudate infarcts, and a cerebellar
tonsillar descent compatible with history of Chiari I malformation. Initial lumbar puncture (LP) was deferred due to congenital brain herniation. Over the next few days, the patient continued to show increasing neurological deficits such as truncal ataxia and increased mood instability. The patient was transferred to the Intensive Care Unit, and LP was obtained under special neuro-critical care direction. Due to increased opening pressures and yeast on gram stain, cryptococcus was suspected and later confirmed. Although antifungal therapy was initiated, the patient continued to deteriorate, leading to cardiac arrest, intubation, and placement of lumbar drain. The patient unfortunately did not demonstrate neurologic recovery following arrest and progressed to brain death.
Discussion: While cryptococcal meningoencephalitis
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