Multivalvular Infective Endocarditis Presenting as Complete Heart Block and Neurological Features Mimicking Meningoencephalitis

A 34-year-old man was admitted with fever, cough, chest pain, headache, and acute confusion, raising an initial suspicion of meningoencephalitis.However, two sets of blood cultures obtained before empirical antibiotic therapy grew methicillin-sensitive Staphylococcus aureus (MSSA), and an electrocardiogram showed complete heart block.His condition deteriorated rapidly, progressing to respiratory failure and cardiogenic shock.Cardiac imaging demonstrated multivalvular infective endocarditis with severe mitral regurgitation secondary to perforation of the mitral leaflet.Emergency valve surgery was undertaken, followed by permanent pacing.This case emphasises the importance of early cardiac assessment in patients with systemic infection and conduction abnormalities, as it highlights an atypical presentation of infective endocarditis mimicking neurological infection.