Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Blood culture-negative infective endocarditis (BCNIE) presents diagnostic challenges, with incidence ranging from 2.5-31%.
• Prior antibiotic therapy is a common factor contributing to negative blood cultures in infective endocarditis.
• BCNIE requires careful consideration due to potential infectious and non-infectious etiologies.

Observation:

• A case of true culture-negative endocarditis involving the mitral valve with multifocal spread (brain, spleen, liver, intervertebral disc) is presented.
• The patient initially received broad-spectrum antibiotics without full resolution, experiencing complications like flail mitral valve and mitral regurgitation.
• Mitra-clip placement was required due to persistent mitral regurgitation.

Findings:

• Persistent negative blood cultures can result from prior antibiotic use, fastidious organisms, or suboptimal techniques.
• Multimodal investigations and multidisciplinary team involvement are crucial for diagnosing and managing BCNIE.
• Upgrading to alternative broad-spectrum antibiotics for an extended duration led to improvement in this complex case.

Implications:

• BCNIE poses significant diagnostic and therapeutic challenges, often associated with high morbidity and mortality.
• Early diagnosis and appropriate, multimodal treatment strategies are essential for improving patient outcomes.
• This case underscores the need for tailored, extended antibiotic regimens and interventions in complex BCNIE cases with widespread infection.