Key result
Six-week IV ceftriaxone successfully treats a case of indolent HACEK endocarditis mimicking malignancy.
Why the study?
HACEK endocarditis is a rare cause of subacute infective endocarditis typically occurring in patients with pre-existing valvular pathology or structural heart disease, posing a diagnostic challenge when presenting indolently as malignancy without traditional risk factors.
Case Report (n=1)
HACEK endocarditis can present with indolent constitutional symptoms mimicking malignancy, highlighting the necessity of transesophageal echocardiography when transthoracic imaging is unrevealing.
BACKGROUND: HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) endocarditis is a rare cause of subacute infective endocarditis typically occurring in patients with pre-existing valvular pathology or structural heart disease. CASE SUMMARY: A 65-year-old male presented with months of night sweats, fevers, anemia, and weight loss concerning for malignancy. Transthoracic echocardiography was negative for vegetations. Blood cultures grew Aggregatibacter actinomycetemcomitans, and transesophageal echocardiography confirmed vegetations on the mitral and aortic valves. The patient was treated successfully with a 6-week course of intravenous ceftriaxone. DISCUSSION: This case highlights the diagnostic challenge of indolent HACEK endocarditis in the absence of traditional risk factors, presenting as malignancy, underscoring the importance of transesophageal echocardiography, even when transthoracic imaging is unrevealing. TAKE-HOME MESSAGE: In patients with persistent constitutional symptoms with negative malignancy workup, HACEK endocarditis should remain in the differential, and transesophageal echocardiography is essential for diagnosis.
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Shusterman et al. (2026) conducted a case report in HACEK endocarditis (n=1). Intravenous ceftriaxone was evaluated on Treatment success. A 6-week course of intravenous ceftriaxone successfully treated a 65-year-old male with indolent HACEK endocarditis presenting with symptoms mimicking malignancy.
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