Central European Journal of Medicine

, Volume 8, Issue 6, pp 795–798 | Cite as

A triad of endocarditis, endophthalmitis, and meningitis

  • Aušra Kavoliūnienė
  • Regina Jonkaitienė
  • Laura Urbonaitė
Case Report


Streptococcus pneumoniae is an uncommon cause of infective endocarditis; it often requires prolonged antibacterial treatment and involves a high mortality rate. We report a rare case of pneumococcal endocarditis manifesting with unusual complications — meningitis and endophthalmitis. Streptococcus pneumoniae species grew from the cerebrospinal fluid. The diagnosis of native aortic valve infective endocarditis was confirmed after some delay by transesophageal echocardiography. The patient’s eye was lost because of infective complications, but his life was saved following an aggressive antibacterial therapy in combination with an immediate aortic valve replacement.


Streptococcus pneumoniae Endocarditis Meningitis Endophthalmitis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Mylonakis E., Calderwood S.B., Infective endocarditis in adults, N. Engl. J. Med., 2001, 345, 1318–1330PubMedCrossRefGoogle Scholar
  2. [2]
    Rueda A.M., Serpa J.A., Matloobi M., Mushtaq M., Musher D.M., The spectrum of invasive pneumococcal disease at an adult tertiary care hospital in the early 21st century, Medicine (Baltimore), 2010, 89, 331–336CrossRefGoogle Scholar
  3. [3]
    Karchmer A.W., Infective endocarditis, In: Bonow R.O., Mann D.L., Zipes D.P., Libby P. (Eds.), Braunwald’s heart disease: a textbook of cardiovascular medicine, 9th ed., Pa: Saunders Elsevier, Philadelphia, 2012Google Scholar
  4. [4]
    Lindberg J., Schønheyder H.C., Møller J.K., Prag J., Incidence of pneumococcal endocarditis: a regional health register-based study in Denmark 1981–1996, Scand. J. Infect. Dis., 2005, 37, 417–421PubMedCrossRefGoogle Scholar
  5. [5]
    Habib G., Hoen B., Tornos P., Thuny F., Prendergast B., Vilacosta I. et al., ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer, Eur. Heart. J., 2009, 30, 2369–2413PubMedCrossRefGoogle Scholar
  6. [6]
    Sexton D.J., Invasive pneumococcal (Streptococcus pneumoniae) infections and bacteremia, available in the UpToDate database (
  7. [7]
    Lee S., Um T., Joe S.G., Hwang J.U., Kim J.G., Yoon Y.H. et al., Changes in the clinical features and prognostic factors of endogenous endophthalmitis: fifteen years of clinical experience in Korea, Retina, 2012, 32, 977–984PubMedCrossRefGoogle Scholar
  8. [8]
    Christensen J.S., Jensen T.G., Kolmos H.J., Pedersen C., Lassen A., Bacteremia with Streptococcus pneumoniae: sepsis and other risk factors for 30-day mortality — a hospital-based cohort study, Eur. J. Clin. Microbiol. Infect. Dis., 2012, 31, 2719–2725PubMedCrossRefGoogle Scholar
  9. [9]
    Wilbring M., Tugtekin S.M., Matschke K., Kappert U., Austrian syndrome in the context of a fulminant pneumococcal native valve endocarditis, Braz. J. Infect. Dis., 2012, 16, 486–488PubMedCrossRefGoogle Scholar
  10. [10]
    Sonneville R., Mirabel M., Hajage D., Tubach F., Vignon P., Perez P. et al., on behalf of ENDOcardite en REAnimation Study Group, Neurologic complications and outcomes of infective endocarditis in critically ill patients: the ENDOcardite en REAnimation prospective multicenter study, Crit. Care Med., 2011, 39, 1474–1481PubMedCrossRefGoogle Scholar
  11. [11]
    Baddour L.M., Wilson W.R., Bayer A.S., Fowler V.G. Jr., Bolger A.F., Levison M.E., Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America, Circulation, 2005, 111, 394–434CrossRefGoogle Scholar
  12. [12]
    Fayad G., Vincentelli A., Leroy G., Devos P., Amr G., Prat A. et al., Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis, J. Thorac. Cardiovasc. Surg., 2012, Google Scholar
  13. [13]
    Kang D.H., Kim Y.J., Kim S.H., Early Surgery versus Conventional Treatment for Infective Endocarditis, N. Engl. J. Med., 2012, 366, 2466–2473PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Aušra Kavoliūnienė
    • 1
  • Regina Jonkaitienė
    • 1
  • Laura Urbonaitė
    • 2
  1. 1.Department of Cardiology, Medical AcademyLithuanian University of Health SciencesKaunasLithuania
  2. 2.Medical AcademyLithuanian University of Health Sciences Kaunas ClinicsKaunasLithuania

Personalised recommendations