Isolated bacterial meningitis as the key syndrome of infective endocarditis

Bacterial meningitis is an unusual first manifestation but a major complication of infective endocarditis. We present three well documented cases of isolated bacterial meningitis in endocarditis. Against this background we review the literature. All patients presented with bacterial meningitis. Staphylococcus aureus was isolated in blood cultures of all patients, but was found only in the cerebrospinal fluid (CSF) of one patient. The underlying endocarditis was confirmed histologically in all three cases. Two patients recovered completely and one died. An extensive search for endocarditis is recommended in every case of an unusual isolate in bacterial meningitis whether it is isolated from blood or CSF.