Alqudah Qusai, Alok Akankcha, Kollu Vidya S
University of Central Florida College of Medicine, Graduate Medical Education, 6850 Lake Nona Blvd., Orlando, FL 32827, USA.
HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA.
IDCases. 2025 Jan 16;39:e02161. doi: 10.1016/j.idcr.2025.e02161. eCollection 2025.
We present a unique case of simultaneous Bartonella and Brucella endocarditis, the first reported instance of this co-infection, highlighting significant diagnostic and therapeutic challenges. A 63-year-old female with a bioprosthetic mitral valve presented with progressive weakness, weight loss, and a persistent dry cough. Evaluation revealed a large mitral valve vegetation, pulmonary nodules, and mediastinal adenopathy. Despite negative blood cultures and an inconclusive malignancy workup, the high clinical suspicion for culture-negative infective endocarditis prompted further serological testing, which confirmed Brucella IgM, IgG and Bartonella PCR positivity. She underwent successful redo mitral valve replacement, with pathology confirming the diagnosis. This case underscores the importance of detailed exposure history, as a kitten from a flea market emerged as a potential infection source. The coexistence of these pathogens highlights the complexity of culture-negative endocarditis and emphasizes the need for prompt, multidisciplinary management to mitigate poor outcomes.
我们报告了一例罕见的同时感染巴尔通体和布鲁氏菌的心内膜炎病例，这是首例关于这种合并感染的报道，突出了显著的诊断和治疗挑战。一名患有生物人工二尖瓣的63岁女性出现进行性虚弱、体重减轻和持续干咳。评估发现二尖瓣有大的赘生物、肺结节和纵隔淋巴结肿大。尽管血培养阴性且恶性肿瘤检查结果不确定，但对培养阴性感染性心内膜炎的高度临床怀疑促使进一步进行血清学检测，结果证实布鲁氏菌IgM、IgG及巴尔通体PCR呈阳性。她成功接受了二尖瓣再次置换手术，病理检查确诊了病情。该病例强调了详细暴露史的重要性，因为一只来自跳蚤市场的小猫被发现是潜在的感染源。这些病原体的共存凸显了培养阴性心内膜炎的复杂性，并强调需要迅速采取多学科管理措施以改善不良预后。
