Subarachnoid Haemorrhage in a Patient With Suspected Infective Endocarditis in a District General Hospital: A Case Report-Based Literature Review

We describe the case of a 70-year-old lady who presented to a district general hospital during an evening with fevers, feeling generally unwell. She was found to have weakness in her left upper limb and went on to have tonic-clonic seizures whilst in the Accident and Emergency Department. CT scan of the brain showed subarachnoid haemorrhage, in absence of headache, in the right frontal, superior parietal and left occipital regions. Her C-reactive protein level was elevated at 426 mg/L and her urine dip was normal. Chest radiograph showed small bilateral pleural effusions. In addition to the above-mentioned findings on clinical examination, she also had pansystolic murmur although did not have any other feature of infective endocarditis (IE). In view of the above findings, normal chest examination and no urinary symptoms, the decision was made to treat this as a case of IE empirically. She subsequently went into fast atrial fibrillation requiring direct current (DC) cardioversion and intensive care unit admission due to hypotension. The next day, echocardiography confirmed vegetations and blood cultures were positive for Staphylococcus aureus. Her MRI scan of the brain confirmed parenchymal haemorrhages and haemorrhagic infarcts. She completed a 6-week course of antibiotics and clinically improved. Despite being critically unwell, appropriate antibiotics were initiated within hours of her admission in view of clinical suspicion of underlying IE, which aided her recovery.