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Bartonella Endocarditis Presenting as Recurrent Cerebral Mycotic Aneurysm
Osakpolor Ogbebor1, Veena Pawate2, Jean Woo3
1Internal Medicine/Infectious Disease and Critical Care, Allegheny Health Network, Pittsburgh, USA.
Cureus
|January 5, 2022
Summary
Bartonella henselae can cause difficult-to-diagnose culture-negative endocarditis, leading to cerebral aneurysms. Persistent evaluation and specific testing are crucial for identifying this infection in patients with neurological symptoms.
Area of Science:
- Infectious Diseases
- Neurology
- Cardiology
Background:
- Bartonella henselae is a recognized cause of culture-negative endocarditis, often presenting diagnostic challenges.
- High clinical suspicion and targeted diagnostic testing are essential for identifying Bartonella henselae endocarditis.
Observation:
- A 48-year-old male experienced recurrent intracranial hemorrhages secondary to cerebral aneurysms.
- Initial echocardiograms and blood cultures were negative for endocarditis, complicating diagnosis.
- Detailed social history revealed cat exposure, prompting Bartonella henselae testing.
Findings:
- Elevated immunoglobulin G (IgG) titers for Bartonella henselae were detected.
- Polymerase chain reaction (PCR) testing confirmed Bartonella henselae in a newly identified middle cerebral artery aneurysm and the explanted mitral valve.
- Warthin-Starry stain results were negative, highlighting limitations of traditional methods.
Implications:
- This case underscores the importance of comprehensive patient history and persistent investigation for diagnosing Bartonella henselae endocarditis.
- Early recognition of culture-negative endocarditis is critical for effective treatment and prevention of severe morbidity and mortality.
- Cerebral aneurysms can be a manifestation of Bartonella henselae endocarditis, necessitating specific diagnostic approaches.
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