A completely healthy 54-year-old woman developed an acute ischemic stroke five weeks after tooth extraction and was later diagnosed with a rare case of infective endocarditis.
After a week's hospital stay and six weeks of intravenous antibiotics, the woman recovered. Prophylactic antibiotics were not prescribed for the tooth extraction procedure because she was considered to be at low risk of developing infective endocarditis. Because of infective endocarditis, such a patient is considered a high-risk patient who requires antibiotic prophylaxis for invasive dental procedures, the authors write.
“Despite an initial low-risk assessment, our patient ultimately developed infective endocarditis as a result of the dental procedure,” wrote the authors, led by Dr. Zachary Wilseck, clinical assistant professor in the Department of Radiology at the University of Michigan Medical School in Ann Arbor.
A woman with no underlying health conditions had her tooth 30 cracked while eating popcorn. She had this tooth removed by her dentist. The woman constantly experienced pain at the site of tooth extraction for two weeks, but did not tell her dentist about it. Moreover, no further visits to the dentist were planned. According to the report, once the pain subsided, the woman began to experience progressive fatigue.
About five weeks after her tooth was removed, the woman was taken to the emergency room because she was having trouble speaking and the right side of her face was drooping.
She underwent CT angiography, which showed occlusion of the left segment of the middle cerebral artery (MCA) with transformation of the distal branches of the midbrain through arterial collaterals. The thrombus was successfully removed and speech and neurological deficits were restored. Additional imaging revealed deep cerebral hemorrhages.
A blood test came back positive for the common oral bacteria Streptococcus mitis, resulting in her being diagnosed with infective endocarditis, believed to be caused by a dental procedure. The patient was started on antibiotics.
Although the endocarditis remained asymptomatic, an echocardiogram revealed aortic regurgitation, mitral valve vegetation, and regurgitation, the authors write.
The woman continued to take antibiotics and was discharged on the seventh day of her hospital stay. Daily injections of ceftriaxone were also prescribed for six weeks.