A Rare Cause of Prosthetic Valve Infective Endocarditis: Francisella tularensis holarctica

Francisella tularensis subspecies holarctica is the most common cause of tularemia in Europe and Japan. Tularemia presents in clinical syndromes, usually as ulceroglandular and glandular syndrome. This entity rarely causes endocarditis. In the United States, only 1 case of a native valve infectious endocarditis has been described to date.

In this article, we report a case of a patient with several weeks of fevers, night sweats, and myalgias who was diagnosed with prosthetic valve infectious endocarditis secondary to Francisella tularensis subspecies holarctica.

Four previous case reports of Francisella tularensis endocarditis have been reported worldwide, with this being the first case of prosthetic valve endocarditis. Antibiotic therapy alone has provided effective treatment in all reported cases of endocarditis.

Infective endocarditis caused by Francisella tularensis is an important entity for physicians to understand in areas of endemicity, especially in cases of culture-negative endocarditis.