Endocarditis Masquerading as Malignancy: Native Valve HACEK Infection

HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) endocarditis is a rare cause of subacute infective endocarditis typically occurring in patients with pre-existing valvular pathology or structural heart disease.

A 65-year-old male presented with months of night sweats, fevers, anemia, and weight loss concerning for malignancy. Transthoracic echocardiography was negative for vegetations. Blood cultures grew Aggregatibacter actinomycetemcomitans, and transesophageal echocardiography confirmed vegetations on the mitral and aortic valves. The patient was treated successfully with a 6-week course of intravenous ceftriaxone.

This case highlights the diagnostic challenge of indolent HACEK endocarditis in the absence of traditional risk factors, presenting as malignancy, underscoring the importance of transesophageal echocardiography, even when transthoracic imaging is unrevealing.

In patients with persistent constitutional symptoms with negative malignancy workup, HACEK endocarditis should remain in the differential, and transesophageal echocardiography is essential for diagnosis.