Open AccessBlood culture-negative endocarditis presenting as altered mental status
Author(s) -
Joshua R Dilley,
C. Randall Clinch
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-224707
Subject(s) - medicine , endocarditis , altered mental status , blood culture , mitral valve , cardiology , abnormality , stroke (engine) , physical examination , complete blood count , surgery , pediatrics , psychiatry , antibiotics , mechanical engineering , microbiology and biotechnology , biology , engineering
Blood culture-negative endocarditis (BCNE) is difficult to diagnose because one of the major criteria to raise suspicion for endocarditis, a positive blood culture, is absent. BCNE accounts for 2.5% to 31% of all cases of endocarditis. Our report describes a 69-year-old woman with end-stage renal disease who presented with altered mental status. Physical examination and testing, including complete blood count, comprehensive metabolic panel, chest X-ray and head CT were otherwise unremarkable. Brain MRI revealed multiple areas of decreased diffusion concerning for cardioembolic stroke. A transthoracic echocardiogram demonstrated an abnormality on the mitral valve. Operative evaluation revealed a purulent mitral valve with vegetative clumps. Cultures of the vegetation and the blood grew no organisms. BCNE is a rare entity; neurological abnormalities may be the only presenting signs/symptoms. Endocarditis should be considered among the causes of altered mental status, even in the absence of positive blood cultures.