[Endocarditis and ischemic stroke of rare cause]

Area of Science:

• Infectious Diseases
• Cardiology
• Molecular Diagnostics

Background:

• Bacterial endocarditis can lead to severe complications like stroke.
• Aortic valve endocarditis requires prompt diagnosis and management.

Observation:

• A 60-year-old male presented with ischemic-embolic stroke.
• Echocardiography revealed aortic valve endocarditis with severe regurgitation.
• Blood cultures and initial valve work-up were negative for pathogens.

Findings:

• Eubacterial PCR (polymerase chain reaction) detected Tropheryma whipplei in the heart valve.
• This identified the causative agent in culture-negative endocarditis.

Implications:

• Molecular diagnostics are crucial for identifying pathogens in culture-negative endocarditis.
• Accurate pathogen identification guides targeted antibiotic therapy (ceftriaxone and trimethoprim/sulfamethoxazole).
• This case underscores the value of advanced molecular techniques in complex cardiovascular infections.