TITLE:
Infective Endocarditis with Negative Cultures: A Defiant Diagnosis
AUTHORS:
Cláudia Rocha, Vera Clérigo, Lígia Fernandes, André Rodrigues, Dora Sargento, Glória Silva
KEYWORDS:
Coxiella burnetii, Endocarditis, Blood Culture-Negative Endocarditis
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.8,
August
11,
2014
ABSTRACT:
The diagnosis and
management of blood culture-negative endocarditis constitute a real clinical
challenge and a systemic approach is necessary for a successful outcome. The
authors report a case of a female patient aged 26, with previous clinical
history of valve disease and heart failure NYHA class II, with decompensation
of co-morbidities associated with fever, productive cough, nonselective
anorexia and unquantified weight loss with one month of evolution with negative
blood cultures. Transesophageal echocardiography revealed the presence of
severe pulmonary hypertension and mitral valve vegetations in the context of
positive serology for Q fever. Herein, the authors report a case of blood
culture-negative endocarditis and present a brief review on the management of
this medical condition. We highlighted the diagnostic difficulties of blood
culture-negative endocarditis and subacute clinical presentation, which
sometimes present with fever of unknown origin and complaints of deterioration
of cardiac function, thus creating a challenging differential diagnosis.