# A Rare Case of Rapidly Progressive Haemophilus Parainfluenzae Endocarditis With Cerebral Emboli

## TL;DR

This case report describes a rare and aggressive infection caused by Haemophilus parainfluenzae, leading to endocarditis and cerebral emboli in a young patient.

## Contribution

The novelty lies in highlighting the acute and severe presentation of a typically subacute infection, emphasizing the need for early diagnosis and treatment.

## Key findings

- Haemophilus parainfluenzae can cause rapidly progressive endocarditis with cerebral emboli.
- Early empirical treatment is crucial to prevent severe complications in such cases.
- Young patients with unexplained fever and neurological symptoms should be evaluated for infective endocarditis.

## Abstract

Haemophilus parainfluenzae, a member of the HACEK group of bacteria, is a rare causative agent of infective endocarditis IE. Typically presenting with a subacute course, Haemophilus parainfluenzae infective endocarditis can, in rare cases, progress acutely, leading to severe complications. This case report highlights a rapid onset of infective endocarditis caused by Haemophilus parainfluenzae, a pathogen not commonly associated with aggressive disease. The infection, accompanied by septic emboli and cardiac involvement, underscores the need for early diagnosis, prompt treatment, and vigilant follow-up. Our patient presented with an acute clinical picture, featuring fever, confusion, and rapid neurological deterioration, necessitating early intervention and targeted therapy. This rapid progression, compounded by cerebral and cardiac complications, highlights the unusual nature of this infection and the challenges it presents in clinical management. The presence of neurological symptoms in a young patient with no history of chronic illness should raise suspicion for IE, especially when accompanied by fever and embolic phenomena. Early empirical treatment is crucial, as it can prevent progression to more severe manifestations. This report also emphasizes the importance of thorough cardiac evaluation in young patients with unexplained fever and neurological symptoms. Structural heart conditions, such as mitral valve prolapse, may predispose individuals to IE, and early detection of such conditions can guide diagnosis and treatment. In our case, the mitral valve involvement was not initially considered, delaying the suspicion of IE. However, once the diagnosis was confirmed, targeted therapy led to a positive outcome.

Haemophilus parainfluenzae IE, though rare, can present acutely with severe complications, including septic emboli and cardiac involvement. This report emphasizes the need for clinicians to maintain a high index of suspicion for infective endocarditis in young patients with persistent fever and neurological symptoms, particularly when embolic manifestations are present. Early recognition, aggressive treatment, and comprehensive follow-up are essential for managing this rare but serious condition. Additionally, this report reinforces the importance of a thorough cardiac evaluation in the differential diagnosis of young patients presenting with fever and embolic events.