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Of Equestrians and Endocarditis

an 80-year old female was transferred from an outside hospital for concerns of a mitral valve vegetation and sepsis. Her past medical history included untreated chronic lymphocytic leukemia (CLL) and atrial fibrillation on warfarin therapy. The patient was otherwise very active and enjoyed daily rides on her horses. She initially presented with altered mental status and was found to be in septic shock with respiratory failure requiring intubation. Initial head CT showed an ischemic stroke in the bilateral frontal lobes. Echocardiogram showed a large mitral valve vegetation. A repeat CT of her head obtained for clinical decline revealed hemorrhagic conversion of her ischemic stroke. She began to have seizure activity that was treated with Keppra. Blood cultures grew Streptococcus zooepidemicus, and she was subsequently transferred to our tertiary medical center for increased level of care.