Isolated Disturbance of Consciousness as Initial Presentation of Staphylococcus aureus Endocarditis: A Case Report With Brief Literature Review.

A man in his 50s with S. aureus infective endocarditis presented with isolated disturbance of consciousness and no history of fever.

• A temperature of 38°C was recorded on admission.
• Classic IE presenting features (fever history, heart murmur, constitutional symptoms) were not the initial manifestation.
• This is a single case report.

Imaging confirmed an extensive acute right hemispheric watershed (border-zone) infarction involving the right temporoparietal lobe.

• There was no evidence of hemorrhagic transformation or intracranial hemorrhage.

Subsequent workup identified S. aureus bacteremia, mitral valve vegetation, and multiple organ dysfunction syndrome.

• The diagnosis of IE was reached only after the neurological presentation was investigated further.
• The 2023 Duke criteria were applied to this case.

The absence of classic IE risk factors contributed to a delayed diagnosis.

• The authors discuss factors contributing to diagnostic delay of IE in this case.
• Disturbance of consciousness as the predominant initial manifestation of S. aureus IE is described as rare and frequently results in diagnostic delay.

Guideline-concordant clinical management was implemented, but long-term outcome data were unavailable because the patient was transferred.

• Only in-hospital mortality after transfer was confirmed.
• The lack of follow-up limits conclusions about outcome.

Clinicians may not routinely consider IE in the differential diagnosis of patients with disturbed consciousness, even though IE is frequently complicated by acute cerebral infarction.

• The authors emphasize maintaining a high index of suspicion for IE in patients with sepsis complicated by acute cerebral infarction.
• This applies particularly to critical care and neurology clinicians.