Infective Endocarditis with Negative Cultures: A Defiant Diagnosis


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.

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Rocha, C. , Clérigo, V. , Fernandes, L. , Rodrigues, A. , Sargento, D. and Silva, G. (2014) Infective Endocarditis with Negative Cultures: A Defiant Diagnosis. Case Reports in Clinical Medicine, 3, 460-464. doi: 10.4236/crcm.2014.38101.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lepidi, H., Durack, D.T. and Raoult, D. (2002) Diagnostic Methods, Current Best Practices and Guidelines for Histologic Evaluation in Infective Endocarditis. Infectious Disease Clinics of North America, 16, 339-361.
[2] Durack, D.T., Lukes, A.S. and Bright, D.K. (1994) New Criteria for Diagnosis of Infective Endocarditis: Utilization of Specific Echocardiographic Findings. The American Journal of Medicine, 96, 200-209.
[3] Anthi, K. and Malek, G.M. (2013) Current Issues in the Diagnosis and Management of Blood Culture-Negative Infective and Non-Infective Endocarditis. The Annals of Thoracic Surgery, 95, 1467-1474.
[4] Brouqui, P. and Raoult, D. (2001) Endocarditis Due to Rare and Fastidious Bacteria. Clinical Microbiology Reviews, 14, 177-207.
[5] European Society of Cardiology Guidelines (2009) Guidelines on the Prevention, Diagnosis, and Treatment of Infective Endocarditis. European Heart Journal, 30, 2369-2413.
[6] Herval, L.B., Heloína, L.M.B., Bassoli, C.A., Lena, M.C.V. and José, R.C.J. (2011) Endocarditis with Negative Blood Cultures and Immunological Changes: A Large Challenge. Acta Reumatol Port, 36, 282-286.
[7] Carvalho, M.S., Trabulo, M., Regina, R., Abecasis, J., Leal da Costa, F. and Mendes, M. (2012) A Case of Infective Endocarditis of Native Valve Immunocompromised Patient. Revista Portuguesa de Cardiologia, 31, 35-38.
[8] Cordero, A., Escoto, V. and Lopes, L. (2008) Endocardite por Bartonella: Um caso de endocarditecom culturas negativas Bartonellaendocarditis: A Case of Culture-Negative Endocarditis. Revista da Sociedade Portuguesa de Medicina Interna, 15, 186-191.
[9] Maria, W., Rune, A., Lars, O. and Harriet, H. (2003) A Clinical Study of Culture-Negative Endocarditis. Medicine, 82, 263-273.
[10] Werner, M., Andersson, R., Olaison, L. and Hogevik, H. (2008) A Ten-Year Survey of Blood Culture Negative Endocarditis in Sweden: Aminoglycoside Therapy Is Important for Survival. Scandinavian Journal of Infectious Diseases, 40, 279-285.
[11] Pierre-Edouard, F., Franck, T., Herve, R., Hubert, L., Jean-Paul, C., Jean-Pierre, A., Max, M., Marie, C., Jean-Luc, M., Thierry, C., Frederic, C., Gilbert, H. and Didier, R. (2010) Comprehensive Diagnostic Strategy for Blood Culture-Negative Endocarditis: A Prospective Study of 819 New Cases. Clinical Infectious Diseases, 51, 131-140.
[12] Werner, M., Fournier, P.E., Andersson, R., Hogevik, H. and Raoult, D. (2003) Bartonella and Coxiella Antibodies in 334 Prospectively Studied Episodes of Infective Endocarditis in Sweden. Scandinavian Journal of Infectious Diseases, 35, 724-727.
[13] Brouqui, P. and Raoult, D. (2001) Endocarditis Due to Rare and Fastidious Bacteria. Clinical Microbiology Reviews, 14, 177-207.

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