Navigating Complexities

Bartonella endocarditis is an exceedingly rare cause of culture-negative endocarditis in the United States and is associated with significant morbidity and mortality. Recent reports suggest growing prevalence in developing countries, emphasizing a high degree of suspicion. We present a case of a formerly homeless patient with Bartonella quintana native aortic and mitral valve endocarditis. This case highlights the importance of high clinical suspicion of Bartonella species among other infectious agents in culture-negative endocarditis in the right clinical settings and the importance of early diagnosis.