PMC9438795_01
Contrast-enhanced CT and MRI of the head on admission. Black arrow indicates cortical convexity subarachnoid hemorrhages of the left frontal lobe (A), multiple subcortical hemorrhages are also observed (B), MRI on T2 FLAIR reveals a hemorrhage (white arrow) in the left frontal lobe gyrus (C), and diffusion-weighted MRI also reveals acute brain infarction (white arrowhead) in the right cerebellar hemisphere (D).
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Although he had no risk factors for stroke, contrast-enhanced computed tomography (CT) revealed cortical convexity subarachnoid hemorrhages (cSAH) of the left frontal lobe, in addition to multiple subcortical hemorrhages in the right frontal lobe and left occipital lobe (Figure 1A and B). Magnetic resonance imaging (MRI) on T2 fluid-attenuated inversion recovery (FLAIR) revealed hemorrhage in the left frontal lobe gyrus (Figure 1C). MRI also revealed acute brain infarction in the right cerebellar hemisphere (Figure 1D). Magnetic resonance angiography revealed no evidence of cerebrovascular malformations, such as aneurysm or obstruction.
Black arrowheads indicated Janeway lesions in the present case.
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In the search of the etiology of multiple hemorrhages and infarction in the brain, repeated thorough physical examinations revealed a heart murmur in the mitral valve area and non-tender erythematous macules on the palms, fingers, toes, and soles recognized as Janeway lesions (Figure 2).
Colonies of S. argenteus (A) and S. aureus (B) on Mannitol Salt Agar (Becton, Dickinson and Company).
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In addition, the isolated strain formed white (non-pigmented) colonies on mannitol salt agar (Becton, Dickinson and Company) incubated at 35 C in ambient air for 48 h (Figure 3A), which is characteristic of S. argenteus, as S. aureus forms gold-colored colonies (Figure 3B).