Simultaneous Multifocal Intracranial Haemorrhages Associated with Staphylococcus Aureus Endocarditis: A Plausible Role for Diclofenac Administration.

Autor:	Tvito A; Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel., Rokach A; Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Ben-David E; Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel., Simons M; Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel., Heyman SN; Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
Jazyk:	angličtina
Zdroj:	European journal of case reports in internal medicine [Eur J Case Rep Intern Med] 2023 Sep 05; Vol. 10 (10), pp. 004044. Date of Electronic Publication: 2023 Sep 05 (Print Publication: 2023).
DOI:	10.12890/2023_004044
Abstrakt:	Introduction: Intracranial haemorrhage may complicate infective endocarditis, caused by ruptured mycotic aneurysms or haemorrhagic transformation of brain septic emboli. The risk of intracranial bleeding may increase with the use of non-steroidal anti-inflammatory agent (NSAIDs). Case Description: We report on a 53-year-old male patient with a past history of intravenous drug abuse, who was treated with diclofenac (75 mg IM) for a few hours of preceding fever and arthralgia. Seven hours later he was hospitalised with impaired consciousness and hemiparesis. Evaluation revealed multiple intracranial haemorrhages, at least one originating from a mycotic aneurysm. Repeated blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and echocardiography revealed a vegetation on the mitral valve, establishing the diagnosis of bacterial endocarditis. Conclusion: The abrupt simultaneous multifocal intracranial bleeds shortly following the administration of NSAIDs for a few hours of febrile disease, one clearly originating from a mycotic aneurism, are exceptional. This raises a possibility of a role for diclofenac the intracranial bleeding diathesis in this unique clinical presentation. Intracranial haemorrhage in the set-up of undiagnosed infective endocarditis (IE) might be added to the long list of potential adverse outcomes of NSAID administration, and the possibility of IE should be considered before their administration for febrile disease of undetermined cause. Learning Points: Intracranial haemorrhage in the set-up of undiagnosed infective endocarditis might be added to the long list of potential adverse outcomes of NSAID administration.The possibility of infective endocarditis should be considered before the administration of NSAIDs for febrile disease of an undetermined cause. Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests. (© EFIM 2023.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu