Spontaneous calcific cerebral embolization revealing a calcified rheumatic mitral stenosis: a case report.

BACKGROUND: Cerebral cardiac embolism accounts for an increasing proportion of ischemic strokes and transient ischemic attacks. Calcified cerebral emboli are rare and mostly iatrogenic secondary to heart or aorta catheterization. However, spontaneous cerebral calcified embolism in the case of calcified aortic valve is very rare and there are less than 10 case reports in the literature. And a more interesting fact is that such an event, in the context of calcified mitral valve disease, has never been reported, at least to our knowledge. We are reporting a case of spontaneous calcified cerebral embolism revealing a calcified rheumatic mitral valve stenosis. CASE PRESENTATION: We report a case of a 59 year-old Moroccan patient, with a history of rheumatic fever at the age of 14 and no history of recent cardiac intervention or aortic/carotid manipulation, who was admitted to the emergency department after a transient ischemic attack. Physical examination at admission found normal blood pressure of 124/79 mmHg and heart rate of 90 bpm. A 12-lead electrocardiogram showed an atrial fibrillation, no other anomalies. Unenhanced cerebral computed tomography imaging was performed, revealing calcified material inside both middle cerebral arteries. Transthoracic echocardiography was performed, showing severe mitral leaflets calcification with a severe mitral stenosis, probably due to rheumatic heart disease. Cervical arteries Duplex was normal. A vitamin K antagonist (acenocoumarol) was prescribed, targeting an international normalized ratio of 2-3 and mitral valve replacement surgery was performed using mechanical prosthesis. Short- and long-term health, with a 1-year follow-up, were good and the patient did not experience any stroke. CONCLUSION: Spontaneous calcified cerebral emboli secondary to mitral valve leaflet calcifications is an extremely rare condition. Replacement of the valve is the only option to prevent recurrent emboli and outcomes are still to be determined.

Urothelial carcinoma associated with infective endocarditis due to a Leuconostoc Species: A rare case report.

Introduction: and importance: Leuconostoc is a genus of gram-positive bacteria, this type of bacteria, which can be found in green vegetables and are used in wine, cheese, and sugar production, is an uncommon cause of disease in human beings. Case report: We report the case of a 60 years old male, with a medical history of nasopharyngeal carcinoma treated by chemotherapy and radiotherapy. The patient was admitted for total hematuria and episodic fever for the last 2 months. blood test found an anemia at 5g/dl, hyperleukocytosis at 18,000/ml,The transthoracic echocardiography showed, moderate mitral regurgitation, severe mitral stenosis with a valve area of 1.5cm2, and a mobile vegetation measuring 14 × 6 mm on A2 part of the anterior mitral valve. Transesophageal echocardiography (TEE) showed a 16 × 8 mm mitral vegetation. An empirical antibiotic therapy then adapted to the antibiogram. Clinical discussion: our patient is at an extremely elevated risk for infective endocarditis. This case is interesting because the pathogenic bacterial species for IE are typically staphylococci and streptococci, Two similar cases of Leuconostoc spp endocarditis were found in the literature, effective therapy of penicillin-resistant group viridians streptococci with combination therapy, our team opted for empiric treatment with ceftriaxone associated to gentamycin. Conclusion: It is critical for clinicians to be aware of the many pathogenic organisms, including Leuconostoc species. It is also clear that a higher index of suspicion must be maintained in patients with multiple predisposing factors such as the patient in the case presented.