Pneumococcal Endocarditis: Historical Insights and Modern Challenges

Abstract

The patient in this case was a 72-year-old female who presented with altered mental status and was ultimately diagnosed with pneumococcal endocarditis. On physical examination, no abnormal cardiac murmurs were detected. This case highlights an important lesson: pneumococcal endocarditis, though rare, is a life-threatening condition with a high mortality rate and should be a top consideration in patients with S. pneumoniae bacteremia, even when the cardiac exam is relatively unremarkable.

Keywords: Austrian; Endocarditis; Osler; Streptococcus pneumoniae.

Fig. 1

Pneumococcal Endocarditis: Echocardiogram, MRI, and Historical Microbiological Depiction. A – Transesophageal echocardiogram: large aortic valve vegetation. B – Brain magnetic resonance imaging: bilateral punctate infarctions in the right parietal, right superior frontal, and bilateral occipital cortex areas. C – Brain magnetic resonance imaging: bilateral cerebellar punctate infarctions. D – William Osler drawing: Osler drew what he saw under the microscope while examining the Chordae tendineae of endocarditis patients: “In it are remarkable micrococcus balls, some of the large size and isolated and others smaller and closely aggregated together.”