Investigations
On day 2 of hospitalization, the patient’s fever worsened to 104 F associated with tachycardia and tachypnea. He was disoriented with left-sided weakness. In view of his worsening lethargy and respiratory distress he was transferred to the ICU. ABG was consistent with metabolic acidosis. MRI head was concerning for intraparenchymal hemorrhage in the right medial cerebellar lobe and subacute cortical infarcts in the right frontoparietal lobe. TTE showed an EF of 42 % and mitral annular calcification with mild regurgitation but no evidence of infective endocarditis (Last TTE 1-year prior showed EF 60%). A lumbar puncture was performed, and CSF analysis revealed xanthochromia, neutrophilic pleocytosis and elevated protein concerning for CSF infection. Blood cultures grew gram-positive rods, Lactobacillus rhamnosus . A TTE did not show any definite vegetation or intracardiac thrombus.