Cerebral aneurysm rupture as the first presentation of infectious endocarditis after placement of contraceptive subcutaneous implant: An unforeseen complication of a regular procedure

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management 2020-12, Vol.22, p.100854, Article 100854
• Main Authors: Nunes Dias, Lídia, Marques, Luís, Rebelo, Marta, Marques, Conceição, Cabral, José
• Format: Article
• Language: English
• Subjects: Contraceptive subcutaneous implant; Infectious aneurysm; Infectious cerebral aneurysm; Infectious endocarditis, cerebral aneurysm
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2020.100854

•Infectious intracranial aneurysms are rare complications of systemic infections.•Subcutaneous contraceptive implantation can also cause a disseminated infection.•Antibiotic therapy (4 to 6 weeks) is the base of any treatment.•Recent treatment approaches are becoming less conservative and more interventional.•Endovascular treatment is surpassing surgery.•Multidisciplinary teams are necessary due to multiple overlapping pathologies. Infectious intracranial aneurysms are rare complications of systemic infections. It occurs mostly in adult-young men in relation to embolization after bacterial endocarditis. A subcutaneous contraceptive implantation is a common procedure and usually occurrence-free. We describe an unforeseen complication of a subcutaneous contraceptive implantation in a young female, the full diagnostic work-up, the most common correlated pathologies, and a brief literature review, in order to propose some «informal guidelines» for any potentially implicated physician. We report a clinical case of a 20-year-old woman with vomiting, prostration and fever (for several weeks) as the first presentation of an intraparenchymal hemorrhage due to a ruptured posterior cerebral artery aneurysm. Further investigations showed a mitral endocarditis with severe mitral regurgitation probably evolving since the placement of a subcutaneous contraceptive implant. After a multidisciplinary discussion the decision was made for the patient to undergo cranial surgery for aneurysmal exclusion and hematoma drainage followed by cardiac surgery. A high suspicion and a multidisciplinary approach is essential for a prompt etiological study in infectious aneurysms and choice of the best treatment of the concurrent pathologies for a good clinical outcome. Minor procedures as subcutaneous contraceptive implantation can also be the cause of catastrophic infectious events, especially if they are overlooked by most physicians.