Isolated Disturbance of Consciousness as Initial Presentation of Staphylococcus aureus Endocarditis: A Case Report With Brief Literature Review
- 1Department of Critical Care Medicine, Shenzhen Luohu People’s Hospital, Shenzhen, Guangdong, PR China
- 2Department of Cardiovascular, Shenzhen Luohu People’s Hospital, Shenzhen, Guangdong, PR China
Abstract
Patient: Male, 50-year-old
Final Diagnosis: Acute cerebral infarction (right temporal-parietal lobe) with secondary right frontal lobe hemorrhage • infective endocarditis • sepsis with MODS
Symptoms: Disturbance of consciousness • fever
Clinical Procedure: —
Specialty: Cardiology • Infectious Diseases • Neurology
Objective: Challenging differential diagnosis
Background: Infective endocarditis (IE) typically presents with fever, a heart murmur, or constitutional symptoms, making diagnosis challenging when neurological manifestations predominate. We report an atypical case of IE in which disturbance of consciousness was the initial manifestation.
Case Report: A man in his 50s was admitted to our hospital with isolated disturbance of consciousness and no history of fever; a temperature of 38 °C was recorded on admission. Investigations confirmed an extensive acute right hemispheric watershed (border-zone) infarction involving the right temporoparietal lobe, without evidence of hemorrhagic transformation or intracranial hemorrhage. Subsequent workup identified Staphylococcus aureus bacteremia, mitral valve vegetation, and multiple organ dysfunction syndrome. The absence of classic IE risk factors contributed to a delayed diagnosis. Guideline-concordant clinical management was implemented. Long-term outcome data were unavailable because of patient transfer; only in-hospital mortality (after transfer) was confirmed. We discuss the application of the 2023 Duke criteria to this case and examine factors contributing to the delayed diagnosis of IE. Disturbance of consciousness as the predominant initial manifestation of S. aureus IE is rare and frequently results in diagnostic delay. This case underscores the importance of maintaining a high index of suspicion for IE in patients with sepsis complicated by acute cerebral infarction, particularly among critical care and neurology clinicians.
Conclusions: This case highlights isolated disturbance of consciousness as an atypical initial presentation of IE. Although IE is frequently complicated by acute cerebral infarction, clinicians may not routinely consider IE in the differential diagnosis of patients presenting with disturbed consciousness.
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BibTeX
@article{zhong2026isolated,
title = {{Isolated Disturbance of Consciousness as Initial Presentation of Staphylococcus aureus Endocarditis: A Case Report With Brief Literature Review}},
author = {Weixiong Zhong and Shanshan Huang and Jing Jiang and Zhixu Tan},
journal = {The American Journal of Case Reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.953169},
url = {https://doi.org/10.12659/ajcr.953169},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Isolated Disturbance of Consciousness as Initial Presentation of Staphylococcus aureus Endocarditis: A Case Report With Brief Literature Review
AU - Weixiong Zhong
AU - Shanshan Huang
AU - Jing Jiang
AU - Zhixu Tan
PY - 2026
DA - 2026/10/27
JO - The American Journal of Case Reports
DO - 10.12659/ajcr.953169
UR - https://doi.org/10.12659/ajcr.953169
AB - Patient: Male, 50-year-old Final Diagnosis: Acute cerebral infarction (right temporal-parietal lobe) with secondary right frontal lobe hemorrhage • infective endocarditis • sepsis with MODS Symptoms: Disturbance of consciousness • fever Clinical Procedure: — Specialty: Cardiology • Infectious Diseases • Neurology Objective: Challenging differential diagnosis Background: Infective endocarditis (IE) typically presents with fever, a heart murmur, or constitutional symptoms, making diagnosis challenging when neurological manifestations predominate. We report an atypical case of IE in which disturbance of consciousness was the initial manifestation. Case Report: A man in his 50s was admitted to our hospital with isolated disturbance of consciousness and no history of fever; a temperature of 38 °C was recorded on admission. Investigations confirmed an extensive acute right hemispheric watershed (border-zone) infarction involving the right temporoparietal lobe, without evidence of hemorrhagic transformation or intracranial hemorrhage. Subsequent workup identified Staphylococcus aureus bacteremia, mitral valve vegetation, and multiple organ dysfunction syndrome. The absence of classic IE risk factors contributed to a delayed diagnosis. Guideline-concordant clinical management was implemented. Long-term outcome data were unavailable because of patient transfer; only in-hospital mortality (after transfer) was confirmed. We discuss the application of the 2023 Duke criteria to this case and examine factors contributing to the delayed diagnosis of IE. Disturbance of consciousness as the predominant initial manifestation of S. aureus IE is rare and frequently results in diagnostic delay. This case underscores the importance of maintaining a high index of suspicion for IE in patients with sepsis complicated by acute cerebral infarction, particularly among critical care and neurology clinicians. Conclusions: This case highlights isolated disturbance of consciousness as an atypical initial presentation of IE. Although IE is frequently complicated by acute cerebral infarction, clinicians may not routinely consider IE in the differential diagnosis of patients presenting with disturbed consciousness.
SN - 1941-5923
ER -