Mycotic aneurysms of the intracranial and peripheral circulation: A rare complication of bacterial endocarditis
A 16-year-old boy presented to us with 5 days history of sudden onset right hemiparesis with speech difficulty. There was also history of recurrent fever for last 6 months.\nHe was also a known case of rheumatic heart disease and was on penicillin prophylaxis for last 5 years.\nOn general physical examination, patient was pale and febrile. The neurologic examination showed spastic dysarthria along with right hemiparesis with medical research council (MRC) grade 4/5 power in right upper and lower limb.\nAmong the routine investigations, urine analysis revealed albuminuria, red blood cells, epithelial cells and hyaline cast suggestive of glomerulonephritis. Echocardiogram was carried out to look for vegetations, but none could be visualized other than severe mitral regurgitation and mild aortic regurgitation with enlarged left atrium and left ventricle. Blood cultures were repeatedly sent in view of history of longstanding recurrent fever and clinical suspicion of bacterial endocarditis, but were negative each time however still a diagnosis of possible infective endocarditis could be made from Duke's minority criteria[] as there was predisposing heart condition, presence of persistent fever, evidence of vascular phenomenon in the form of mycotic aneurysm and intracranial hemorrhage (as detailed in discussion) and immunological phenomenon in the form of glomerulonephritis.