Neurological Complication of Infective Endocarditis Mimicking Temporal Arteritis

scan showed a suprasellar SAH, extending toward pons and occipital lobes. General examination showed cardiac systolic apical murmur. Blood tests confirmed the presence of anemia (RBC 3,000,000 mm 3 , Hb 9 M ), elevation of C-reactive protein (106 M ) and fibrinogen (816 M ). Angio-CT of cerebral vessels did not show any aneurysm or vascular malformation. We decided to submit the patient to angio-CT, although CT is not the gold standard test to detect intracranial mycotic aneurysms, because of patients’ age and general conditions. A retinal fluoroangiography documented an acute ischemic optic neuropathy with bilateral branches occlusion of retinal arteries. Blood cultures showed the presence of Streptococcus anginosus , and a transthoracic echocardiography showed endocardic strands in mitral and pulmonary valves with severe mitral regurgitation. Intravenous antibiotic therapy with gentamicin and ampicillin/sulbactam was started. A follow-up CT scan done after 1 week from admission, 2 days after antibiotic treatment was started, showed an asymptomatic small parenchymal left occipital hemorrhage. The patient was evaluated by cardiosurgeons, who suggested valve replacement, and he underwent surgical intervention a month after discharge from our ward. No neurological or cardiological Dear Sir, Infective endocarditis (IE) can present with systemic embolizations [1] , which most frequently involve the central nervous system [2] . Intracerebral or subarachnoid hemorrhage (SAH), due to the rupture of mycotic aneurysm or to the rupture of pyogenic arteritis, is a less frequent complication of IE [3] . A few cases of retinal arterial occlusion as a complication of infectious endocarditis have been described [4–6] . We report the case of an uncommon presentation of infectious endocarditis with concomitant ischemic and hemorrhagic manifestations in the central nervous system, with clinical aspects similar to temporal arteritis.