Surgical strategy in a patient with combined infective endocarditis of pseudomonas putida and metisiline sensitive staphylococcus, complicated with splenic infarction cerebral abscess.

Method Transthoracic echocardiography revealed a vegetative lesion on mitral valve. Combined parenteralantiobiotheraphy was admitted. Blood cultures and antibiograms resulted with metisiline sensitive Staphylococcus Aureus and Pseudomonas Putida 10 days after. Patient was consulted to infectious disease department and continuation of antibiotics was decided. His abdominal CT revealed splenic infarct and cerebral CT revealed a 2 cm lesion located in left temporal lobe with peripheral edema. Cerebral MR examination revealed hypo intense cortical changes with hemorrhagic content that is settled by embolization. This was reported as an infective disease like cerebritis or multiple abscess formation. Neurosurgery consultation resulted as operation indication was going to be decided by patients response to antibiotheraphy and treatment of cardiac pathology has priority. In addition, they reported that elective surgery should planned after control cranial MR examination and there was not any risk for anticoagulation. Coronary angiography was normal but catheterization revealed serious mitral valve insufficiency.