Chlamydia psittacosis infection complicating cerebral infarction: A case report and literature review.

RATIONALE: Chlamydia psittaci (CP) pneumonia is a rare zoonosis. Severe infection predisposes patients to thrombotic complications; however, only 2 documented cases of delayed cerebral infarction occurring during anticoagulant therapy exist in the literature.

PATIENT CONCERNS: A 60-year-old female with a history of hypertension and a concealed history of avian exposure presented with fever, chest tightness, and dyspnea. Examination revealed severe hypoxemia (PaO2 46.8 mm Hg), systemic inflammation (C-reactive protein 343.65 mg/L), and multi-organ dysfunction.

DIAGNOSES: CP pneumonia; cerebral infarction.

INTERVENTIONS: Following definitive diagnosis via metagenomic next-generation sequencing of bronchoalveolar lavage fluid, targeted antimicrobial therapy with omadacycline (100 mg daily) and moxifloxacin (400 mg daily) was initiated immediately. Concurrent interventions included mechanical ventilation and prophylactic anticoagulation with enoxaparin (5000 IU daily). Upon development of an acute cerebral infarction, the antithrombotic strategy was modified: anticoagulation was discontinued and dual antiplatelet therapy (aspirin 100 mg/d + clopidogrel 75 mg/d) was commenced, alongside early rehabilitation in a dedicated stroke unit.

OUTCOMES: By day 5 of antimicrobial therapy, inflammatory markers decreased significantly and oxygenation improved. Neurological function showed partial recovery by day 14 postinfarction (National Institutes of Health Stroke Scale score reduced from 8 to 3), enabling successful weaning from ventilation and hospital discharge.

LESSONS: Active screening for avian contact history and early application of metagenomic next-generation sequencing should be considered in patients with severe pneumonia. CP infection can trigger immunothrombosis, warranting vigilance for delayed stroke even during anticoagulation. Multidisciplinary management is crucial for optimizing outcomes in infection-associated cerebral infarction.