An unusual cause of central diabetes insipidus

Abstract

Introduction: Central diabetes insipidus (CDI) is a heterogeneous condition characterized by the presence of polyuria and polydipsia due to a deficiency of vasopressin. In 1950, the first case of CDI associated developing in the setting of infective endocarditis was reported. We hereby report a similar case of diabetes insipidus (DI) complicating a case of bacterial endocarditis. Aims and Objective: We aim to discuss the rare case of DI with infective endocarditis and to review the literature. Materials and Methods: A 54-year-old woman presented with high-grade fever and loss of appetite. She had undergone aortic valve replacement with coronary artery bypass graft surgery 1 month back. Investigations revealed prosthetic valve endocarditis secondary to coagulase-negative Staphylococcus. During a hospital stay, the patient had a cardiac arrest. Postresuscitation patient developed refractory shock. Echocardiography showed new-onset septoapical hypokinesia and paravalvular abscess. The diagnosis of myocardial infarction due to embolism of the vegetation was considered. The patient showed gradual improvement with antibiotics, mechanical ventilation, and supportive care. While recovering, the patient developed persistent polyurea. Laboratory abnormalities included hypernatremia, elevated serum osmolality, and low urine osmolality. She improved with fluid, desmopressin and sodium levels were stabilized. Based on clinical, laboratory, and magnetic resonance imaging findings and response to desmopressin, the diagnosis of CDI was made. On follow-up, the patient is maintaining sodium and urine output on daily 100 mcg desmopressin. Results: Thus, we report a case of permanent DI developing in the setting of infective endocarditis. Discussion and Conclusion: The ischemic insult to pituitary either due to embolization of posterior pituitary or hypoperfusion secondary to cardiac arrest may have resulted in DI. The case highlights monitoring for DI in the setting of cardiac arrest and infective endocarditis. Early recognition and correction of hypernatremia may prevent further brain injury.