Introduction: Neurological complications are a common cause of morbidity and mortality in patients with infectious endocarditis. The most frequent complications include cerebral infarction, intracerebral hemorrhage, meningitis, cerebral abscess and mycotic aneurysm. But, bacterial meningitis as a presenting symptom of infective endocarditis is rare.

Methods: We describe a pediatric patient who developed bacterial meningitis as a presenting symptom of mitral valve endocarditis.

Case Description: The patient is a 15-year old girl without any past cardiac disease. Following an initial two weeks period of malaise and headache, she was admitted to the hospital with fever, headache and meningeal irritation signs. The clinical symptoms, the laboratory examinations and lumbar puncture supported the diagnosis of bacterial meningitis. After prompt empirical antibiotics were given, headache and meningeal irritation signs were resolved immediately. But, fever and high level of systemic inflammatory markers were continued, even though repeated lumbar puncture revealed almost complete resolution of meningitis. We searched for another focus of fever at the 7 day after admission. Finally she diagnosed with a mitral valve endocarditis and treated with valve replacement.

Result: Diagnosis of infectious endocarditis was delayed for 7 days due to lack of clinical signs and symptoms likewise murmur.

Conclusion: Bacterial meningitis can be a presenting manifestation of infective endocarditis. Underlying infective endocarditis should be diligently sought in any patient presenting with bacterial meningitis, even if typical signs and symptoms are initially absent.