SHM Converge Scientific Abstract ePoster Gallery-Blinded and Deceived: Infective Endocarditis Presenting as Cortical Blindness

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A 43-year-old man presented with 2 days of complete bilateral vision loss and became severely agitated in the emergency department, requiring repeated IV benzodiazepines. He was afebrile but tachycardic, and exam showed classic Cushingoid features: moon facies, centripetal obesity, purple striae, and a buffalo hump, along with swollen, erythematous hands. Initial workup with CT head and lumbar puncture was negative. Laboratory studies showed leukocytosis, markedly elevated troponin, and high ferritin.<br /><br />Further history revealed that he had been self-administering IV dexamethasone for unexplained hand swelling. MRI of the brain demonstrated diffuse septic emboli affecting the occipital lobes, explaining his cortical blindness. CT of the abdomen showed splenic infarcts. Transthoracic echocardiography identified a 1.5 cm aortic valve vegetation, and serial blood cultures grew methicillin-sensitive Staphylococcus aureus, confirming infective endocarditis with systemic embolization.<br /><br />The patient underwent aortic valve replacement and repair of a coronary sinus annular abscess on hospital day 6. He was treated with 8 weeks of nafcillin and ultimately had resolution of his blindness.<br /><br />This case highlights that sudden bilateral blindness can be a rare presentation of infective endocarditis, caused by septic emboli to the occipital lobes. Brain MRI is critical for detecting ischemic injury in such cases. The report emphasizes the importance of early diagnosis and treatment, including prompt antibiotic therapy and timely surgical intervention, both of which can reduce mortality and improve neurologic outcomes.

Asset Subtitle

Jodi-Ann S. Smith

Meta Tag

Author List Devon Scott, Doo Wong Choi, Jodi-Ann S. Smith, Mahmoud Abdelhadi, Samarth Beri, Sharif Chebbo, Tanganyika Barnes

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Transient Cortical Blindness

Concept Neurologic Deficit

Concept Septic Emboli

Concept Cerebral Infarction

Distinguished Non-Finalist

Presenter Organization Englewood Hospital

Presenting Author Jodi-Ann S. Smith

Track Adult

Keywords

cortical blindness

infective endocarditis

septic emboli

bilateral vision loss

aortic valve vegetation

methicillin-sensitive Staphylococcus aureus

brain MRI

occipital lobes

splenic infarcts

aortic valve replacement

Infective Endocarditis

Transient Cortical Blindness

Neurologic Deficit

Septic Emboli

Cerebral Infarction