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Background: Bacterial endocarditis is a rare infectious entity with a very heterogeneous clinical spectrum;neurological manifestations are the most frequent and serious extracardiac complications of infectiveendocarditis. However, little is known about the psychiatric manifestations and / or sequels due to septicembolism of the infective endocarditis.Case Report: 50-year-old male, history of arterial hypertension and nephrolithiasis with recurrent urinarytract infections. He began his condition with behavioral changes characterized by marked impulsivity andinstability in his interpersonal relationships, adding repetitive events of fever and nephrolithiasis requiringurological interventions and antibiotic therapy. Upon admission assessed by psychiatry because of hisimpulsive behavior and emotional changes with the presumptive diagnosis of borderline personalitydisorder.Conclusion: In the following work we describe the first case found in the literature of a psychiatricmanifestation in a male patient as the initial complication of a subacute bacterial endocarditis, his diagnosticapproach, clinical picture and therapeutic outcome. The early recognition of the clinical picture and thediagnostic approach allowed to establish effective antibiotic treatment; to recognize that bacterialendocarditis might present in a multifaceted way allows to suspect this disease and give treatmentopportunely to reduce its burden and mortality.

Personality Disorder as the Initial Presentation of a Complicated Endocarditis: Diagnostic Challenges in the CARDIO-PSYCHIATRY