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.