Stroke after Erysipelothrix Rhusiopathiae Endocarditis: A Case Report.

Abstract: Erysipelothrix rhusiopathiae is a rare cause of infective endocarditis (IE). This study aims to report the fifth known case of intracranial manifestation resulting from E. rhusiopathiae endocarditis. Moreover, we aim to address the main epidemiological and clinical aspects associated with this issue. A 62-year-old retired bird breeder presented with left-sided appendicular ataxia and hemiparesis. Diagnostic tests revealed endocarditis caused by E. rhusiopathiae. He received a 6-week antibiotic course, including ampicillin, which resulted in neurological and cardiac improvement. Follow-ups demonstrated no recurrence, and he was discharged from both neurology and cardiology 1 year later. The low virulence of the E. rhusiopathiae pathogen explains the minimal frequency of intracranial manifestations associated with the infection. However, patient's overall condition is a decisive factor in this context. This is the first reported case concerning presumed transmission by birds. Physical manifestations are more commonly found in IE involving the mitral valve compared to the aortic and tricuspid valves. Even with appropriate treatment, mortality from endocarditis associated with E. rhusiopathiae can exceed 38%. Furthermore, IE by this microorganism often causes extensive valve damage. The positive outcome of this case emphasizes the significance of prompt recognition and appropriate management. This report highlights the need for clinical awareness regarding E. rhusiopathiae as an etiological agent for IE and its potential complications, including stroke.