Bartonella henselae endocarditis in an elderly patient

Abstract

We report an 85-year-old white man admitted to the emergency department of the University of Campinas with fever of undetermined origin (FUO) who received antibiotics previously. Initially, the hypothesis was pneumonia. He presented a drug reaction misdiagnosed as staphy-lococcal desquamation. The follow-up confirmed that prolonged fever was caused by bacterial endocarditis by transthoracic echocardiogram that showed vegetation in the aortic valve. Bar-tonella henselae etiology was confirmed by PCR. This case reinforces the difficulty of diagnosing Bartonella sp. infection; this etiology must be considered even in patients with negative serology. The criteria for the diagnosis of bacterial endocarditis should contemplate a molecular positivity investigation for Bartonella spp, such as PCR in blood or serum samples as a major Duke criterion, even if with titers lower than 1 to 800.