Endocarditis Caused by Bartonella quintana: A Case Report

TL;DR

This paper reports a rare case of endocarditis caused by Bartonella quintana, involving three heart valves and presenting with a stroke as the first symptom.

Contribution

The case highlights the unusual multisite valvular involvement and atypical presentation of Bartonella quintana endocarditis.

Findings

The patient had B. quintana endocarditis affecting three cardiac valves simultaneously.

The initial symptom was a massive ischemic stroke, an atypical presentation of endocarditis.

Systemic embolization, including to the spleen, was observed in this case.

Abstract

Infective endocarditis (IE) is a complex and potentially life-threatening condition characterized by infection of the heart's endocardial surface, often leading to systemic complications. Historically recognized as a distinct pathological entity, IE has been associated with a wide range of bacterial pathogens, with Bartonella species emerging as a notable cause in recent years. Among these, Bartonella quintana is a rare but significant etiological agent, particularly in cases of culture-negative endocarditis. The management of Bartonella-induced IE remains challenging due to the evolving understanding of its pathophysiology and the need for tailored therapeutic strategies.

We present a unique case of a patient with B. quintana IE, remarkable for its simultaneous involvement of three cardiac valves - mitral, tricuspid, and aortic - each exhibiting vegetations. This multisite valvular involvement is an uncommon and distinctive feature, underscoring the aggressive nature of the infection. Notably, the patient's initial presentation was a massive ischemic stroke in the territory of the middle cerebral artery, an atypical manifestation of IE that highlights the potential for cardioembolic complications as the first clinical sign. Further evaluation revealed additional systemic embolization, including septic emboli to the spleen, further complicating the clinical picture.

This case underscores the importance of considering IE in patients presenting with embolic stroke, even in the absence of classic symptoms such as fever or heart failure. It also emphasizes the need for a high index of suspicion for Bartonella species in culture-negative endocarditis, particularly in cases with multisite valvular involvement and systemic embolic phenomena. Early diagnosis and targeted treatment are critical to improving outcomes in this rare but devastating condition.

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