CASE REPORT


Convexity Subarachnoid Hemorrhage, Pseudomonas Aeruginosa (PA) Infective Endocarditis and Left Atrial Appendage Occluder (LAAO) Device Infection. A Case Report



Monique Boukobza1, *, Ibtissem Smaali1, Xavier Duval2, Jean-Pierre Laissy3
1 Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
2 Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM Clinical Investigation Center 007, (S.T., X.D.) and INSERM U738, (C.L., X.D.) Université Paris Diderot, Sorbonne Paris Cité, France
3 Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France


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© 2017 Boukobza et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018, Paris, France, Tel:+ 33624652932; Fax:+ 33140258305; E-mails: monique.boukobza@aphp.fr; m.boukobza@orange.fr


Abstract

An 83 year-old-man with left atrial appendage occluder (LAAO) developed Pseudomonas Aeruginosa (PA) infective endocarditis. MRI at day 3 of onset showed distal small infarcts in both middle cerebral arteries and left postero-inferior cerebellar artery territories. MRI at day 6 revealed two sites of convexity subarachnoid hemorrhage (cSAH). MRA and CTA failed to reveal a Mycotic aneurysm.

The radiologic findings favor the assumption of necrosis of distal branches of mca or of pial arteries wall.

This case present three unusual features: the presence of localized cSAH after initiation of antibiotherapy without mycotic aneurysm being individualized; the late occurrence of infective endocarditis after LAAO implantation; the very rare occurrence of PA in prosthetic infections.

Keywords: Infective Endocarditis, Convexity subarachnoid hemorrhage, T2-GRE images, Mycotic aneurysm, Pseudomonas Aeruginosa, Left atrial appendage occluder.