Endocarditis Caused by Bartonella quintana: A Case Report

Infective endocarditis (IE) is a complex and potentially life-threatening condition characterized by infection of the heart's endocardial surface, often leading to systemic complications. Historically recognized as a distinct pathological entity, IE has been associated with a wide range of bacterial pathogens, with <i>Bartonella</i> species emerging as a notable cause in recent years. Among these, <i>Bartonella quintana</i> is a rare but significant etiological agent, particularly in cases of culture-negative endocarditis. The management of <i>Bartonella</i>-induced IE remains challenging due to the evolving understanding of its pathophysiology and the need for tailored therapeutic strategies. We present a unique case of a patient with <i>B. quintana</i> IE, remarkable for its simultaneous involvement of three cardiac valves - mitral, tricuspid, and aortic - each exhibiting vegetations. This multisite valvular involvement is an uncommon and distinctive feature, underscoring the aggressive nature of the infection. Notably, the patient's initial presentation was a massive ischemic stroke in the territory of the middle cerebral artery, an atypical manifestation of IE that highlights the potential for cardioembolic complications as the first clinical sign. Further evaluation revealed additional systemic embolization, including septic emboli to the spleen, further complicating the clinical picture. This case underscores the importance of considering IE in patients presenting with embolic stroke, even in the absence of classic symptoms such as fever or heart failure. It also emphasizes the need for a high index of suspicion for <i>Bartonella</i> species in culture-negative endocarditis, particularly in cases with multisite valvular involvement and systemic embolic phenomena. Early diagnosis and targeted treatment are critical to improving outcomes in this rare but devastating condition.