Recurrent intracerebral haemorrhage in a 24-year-old female patient

• Published in: Der Internist (Berlin) Vol. 63; no. 1; p. 103
• Main Authors: Hipp, S, von der Emde, W, Kulke, C, Schlotter, M, Schmidt, J, Kikhney, J, Hopf, A G M, Moter, A, Eszlari, E, Eichinger, W, Hinterseer, M
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2022
• Subjects: Adult; Aortic Valve; Bartonella quintana - genetics; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - diagnostic imaging; Endocarditis, Bacterial; Female; Humans; In Situ Hybridization, Fluorescence; Neoplasm Recurrence, Local; Trench Fever; Young Adult; In situ hybridization, fluorescence; Infective endocarditis; Left ventricular noncompaction; Bartonella quintana; Trench fever
• ISSN: 1432-1289
• DOI: 10.1007/s00108-021-01157-z

A 24-year-old female patient from Sierra Leone was referred to the authors' hospital after several unclear intracerebral bleeding events and an echogenic structure on the aortic valve. The patient was receiving oral anticoagulation therapy due to paroxysmal atrial fibrillation and left ventricular noncompaction. Fluorescence in situ hybridization in combination with polymerase chain reaction and sequencing revealed infective endocarditis of the mitral and aortic valve caused by Bartonella quintana. In retrospect, the intracerebral bleeding events could be identified as septic emboli with secondary haemorrhagic transformation under anticoagulation therapy. The patient showed significant clinical improvement and no further bleeding events occurred after receiving biological mitral and aortic valve replacement and several weeks of doxycycline and gentamicin antibiotic therapy.