Title:Case Report: Culture-negative Prosthetic Valve Endocarditis
Volume: 19
Issue: 6
Author(s): Ignacio D. Velazquez*, Kenneth K. Woo, Mohammed Siddiqui and Sion K. Roy
Affiliation:
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
Keywords:
Fungal endocarditis, aspergillus endocarditis, prosthetic valve endocarditis, culture-negative infective endocarditis, transesophageal echocardiograms, treatment.
Abstract:
Background: Prosthetic valve endocarditis can be difficult to diagnose and cause significant
morbidity and mortality, especially when no culture data are available to guide therapy.
Transthoracic and transesophageal echocardiograms, the studies of choice for initial endocarditis
evaluation, can be less reliable due to artifact and post-surgical changes. Some less common forms
of endocarditis may be difficult to culture and, due to their fastidious nature, may delay the identification
of causative organisms. Given the lack of directed antimicrobial treatment, culturenegative
prosthetic valve endocarditis is specifically difficult. A wide differential diagnosis is critical
to make a timely diagnosis and initiate treatment.
Case Presentation: We present a case of a patient presenting with dyspnea which was found to
have culture-negative endocarditis requiring mitral and aortic valve replacement that ultimately
was complicated with culture-negative prosthetic valve endocarditis. Identifying a culprit organism
made appropriate and timely antimicrobial treatment difficult, ultimately resulting in the patient
dying from endocarditis complications.
Conclusion: A high index of suspicion is needed when managing infective endocarditis, especially
when prosthetic valves are involved. Diagnostic accuracy of cultures and echocardiography may be
reduced when dealing with prosthetic valve endocarditis; thus, alternative methods of diagnosis
may be required to make a timely diagnosis of causative organisms.
