Histopathological examination of an embolus in infective endocarditis: Case report and review of the literature

Abstract

A 62-year-old woman with history of chronic back pain and vertebral osteomyelitis presented with right hemiparesis and aphasia with last known well 10 h prior to presentation and a CT angiography demonstrating a left M1 occlusion. A thrombectomy was performed with resultant TICI-2b improving NIHSS from 28 pre-thrombectomy to 19 post-thrombectomy. Pathologic examination of the embolus demonstrated abundant bacterial colonies. While echocardiography was negative for valvular vegetations, fluoroscopy demonstrated abnormal mechanical valve motion. Blood cultures grew Enterococcus faecalis for which antibiotics were initiated. NIHSS continued to improve to a score of 12. There are rare cases in the literature that discuss diagnosis and initiation of antibiotics assisted by histopathologic examination of the embolus. Routine histopathologic evaluation of emboli may facilitate timely diagnosis and early antibiotic initiation in the setting of septic emboli. Keywords: Acute ischemic stroke, Infective endocarditis, Septic embolus, Thrombectomy