Infective endocarditis complicated with multiple cerebral embolism and hemorrhage caused by Streptococcus sinensis: a rare case report and literature review.

Streptococcus sinensis (S. sinensis) is a rare pathogen causing infective endocarditis (IE). We report a 68-year-old Chinese man with S. sinensis-associated IE complicated by cerebral infarction with hemorrhagic transformation. He presented with fever, aphasia, arthralgia, arthritis, and right hemiparesis. Initial transthoracic echocardiography was negative for vegetations; valve-adjacent vegetations were identified until after neurological stabilization. Antimicrobial therapy was adjusted iteratively according to culture and susceptibility results. Linezolid plus cefazolin for 4 weeks achieved his condition stabilization; the patient declined valve replacement and was discharged. Oral linezolid plus moxifloxacin was continued for another 4 weeks, with sustained stability. S. sinensis IE can involve the central nervous system. Early pathogen identification and targeted antimicrobial therapy are crucial for better outcomes.