Cerebral Hemorrhage as a Presenting Feature of Infective Endocarditis

This case report describes a rare and fatal presentation of infective endocarditis (IE) initially manifesting as intracerebral hemorrhage due to a ruptured mycotic aneurysm. A 50-year-old man with atrial fibrillation presented with headache, fever, confusion, and hemiparesis. Brain imaging revealed left-sided hemorrhage, and echocardiography identified a mitral valve vegetation. Blood cultures grew Staphylococcus xylosus, a coagulase-negative staphylococcus. Despite empiric treatment with vancomycin and gentamicin, the patient's clinical status deteriorated with the onset of severe pulmonary edema and acute mitral regurgitation. Surgical intervention was indicated but could not be performed before the patient suffered a fatal cardiorespiratory arrest. This study underscores the diagnostic complexity and therapeutic dilemma in managing IE complicated by intracranial hemorrhage. It highlights the need for early multidisciplinary collaboration, careful risk–benefit assessment for cardiac surgery in the setting of recent cerebral bleeding, and vigilance for neurological complications in febrile patients with predisposing cardiac conditions.