Endocarditis, Meningitis and Pneumocystis Pneumonia

Infective endocarditis (IE) is associated with high morbidity and mortality despite advances in antibiotic and surgical treatment. Systemic embolism occurs in up to 49% of IE patients and may involve the major arteries, limb arteries, viscera and the central nervous system. In this report we describe a 60-year-old female patient with a history of acute lymphoblastic leukaemia who presented with endocarditis manifesting as stroke, acute limb ischaemia and meningitis. Early diagnosis is essential since treatment lowers the risk of embolism, with most events occurring within 2 weeks of treatment initiation. LEARNING POINTS: Infective endocarditis has a very variable clinical presentation and should be suspected in patients with multisystemic involvement especially if vascular and neurological systems are affected. As early diagnosis is essential since treatment lowers the risk of embolism, echocardiography should be more widely available and possibly become a core medical skill. Because of the high mortality, a high index of suspicion and low threshold for investigation is essential in at-risk groups.