Key result
MVR and antibiotics resolve culture-negative endocarditis complicated by severe MR and chordal rupture.
Why the study?
Infective endocarditis carries high mortality, and while blood cultures are diagnostic criterion, culture-negative endocarditis presents diagnostic and therapeutic dilemmas that require prompt identification.
Case Report (n=1)
No
Culture-negative endocarditis presents a diagnostic challenge that requires a high index of suspicion, multimodal imaging, and prompt multidisciplinary treatment including surgery to manage severe complications like chordae tendineae rupture.
Highlights need for multidisciplinary care in complex endocarditis; leaves open optimal strategies pending larger studies.
Infective endocarditis has a high mortality rate. Criterion for diagnosis is a positive blood culture, however, some cases present with negative blood culture. We present a 65-year-old male complaining of palpitations. EKG showed atrial fibrillation with RVR. Transthoracic echocardiogram showed severe mitral regurgitation and possible vegetation. Transesophageal echocardiogram revealed endocarditis with ruptured chordae and vegetation on the posterior leaflet. All obtained blood cultures remained negative. Cardiothoracic surgery and infectious disease specialties were consulted. Patient was started on broad spectrum antibiotics. Patient underwent a mitral valve replacement and pathology showed focal myxoid degeneration with no inflammation and cultures of the specimen were negative. The hospital course was complicated by hemopericardium, treated by pericardial window, and drain placement. The patient was ultimately discharged to an acute rehabilitation center. Culture-negative endocarditis presents a diagnostic and therapeutic dilemma for clinicians and should be promptly identified and treated to avoid complications.
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Adelkhanova et al. (2024) conducted a case report in Blood culture negative endocarditis (n=1). Mitral valve replacement and antibiotics was evaluated. A 65-year-old male with blood culture-negative endocarditis complicated by severe mitral regurgitation and chordae tendinea rupture was successfully treated with mitral valve replacement and antibiotics.
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