Culture-Negative Endocarditis Complicated by Cerebral Abscesses Due to Streptococcus gordonii: A Diagnostic Odyssey

Endocarditis is a serious diagnostic entity that carries a high rate of morbidity and mortality, with complications including heart failure, septic embolization, brain abscesses, and stroke. Blood culture-negative endocarditis (BCNE) represents a particularly challenging clinical scenario where the causative organism is undetectable, either due to being difficult to culture or due to the empiric administration of antimicrobial agents. This entity generally results in delayed diagnosis and treatment of endocarditis, with a potential increase in the rate of complications. In this report, we present a case of multiple brain abscesses resulting from BCNE, where the causative organism - and hence effective treatment - was only identified with the implementation of modern molecular diagnostic techniques like Karius, isothermal amplification methods, etc. We also highlight the specific entities of BCNE, its pathogenesis, and differential diagnosis, as well as the effective diagnostic and therapeutic options available to date.