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Challenges in the Clinical Management of Blood-Culture Negative Endocarditis: Case of Bartonella henselae Infection

To the Editor: A 53-year-old Caucasian man presented with an episode of syncope, nausea, vomiting, and 6 weeks of recurrent fevers (up to 40°C). He had a congenital bicuspid aortic valve for which he underwent aortic valve replacement in 1976, a second aortic valve replacement for blood-culture positive bacterial endocarditis in 1986, and a third aortic valve replacement in 1999 for prosthetic valve failure. He reported no recent travel but had multiple pets, including rabbits, cats, kittens, and hamsters.</P>Physical examination showed a heart rate of 103 beats/min, blood pressure of 73/50 mm Hg, fever of 39.5°C, and oxygen saturation via pulse oximetry of 100% on room air. Heart examination demonstrated tachycardia and 2/6 systolic murmur at the right upper sternal border. No stigmata of endocarditis were observed. Chest radiograph was normal. Electrocardiogram demonstrated sinus tachycardia and an interventricular conduction delay.</P>Laboratory values were significant for the following: white blood cell 6.7 × 10 3 /μL, platelets 70 × 10 3 /μL, sodium 103 mmol/L, blood urea nitrogen 56 mg/dL, and creatinine 2.08 mg/dL. Troponin level was 0.69 mg/dL with normal creatine phosphokinase and creatine kinase-MB. Bacterial and fungal blood cultures were negative. Transthoracic and transesophageal echocardiograms were negative for http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Medicine Elsevier
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