Infectious intracranial aneurysms caused by Granulicatella adiacens

Infectious intracranial aneurysms (IIAs) are uncommon but severe complications of bacterial endocarditis. We report a case of IIA due to a rare nutritionally variant streptococcus, Granulicatella adiacens. The 31-year-old young patient, without any known risk for infective endocarditis had a silent clinical course until rupture of IIAs occurred. Despite antibiotic treatment and surgical clipping of IIAs, a second episode of more severe intracerebral hemorrhage occurred four months later. Mitral valvuloplasty was undertaken and there were no more brain insults in the following four years. Awareness of the possibility of hemorrhagic stroke as the initial presentation of Granulicatella adiacens endocarditis, and the possibility of high recurrence and bacteriological failure rate of Granulicatella adiacens infection may be helpful in early diagnosis and surgical decision, thus limiting future fatal complications.