Published: July 30, 2020


We report an 85-year-old white man admitted to the emergency department of the University of Campinas with fever of undetermined origin (FUO) who received antibiotics previously. Initially, the hypothesis was pneumonia. He presented a drug reaction misdiagnosed as staphylococcal desquamation. The follow-up confirmed that prolonged fever was caused by bacterial endocarditis by transthoracic echocardiogram that showed vegetation in the aortic valve. Bartonella henselae etiology was confirmed by PCR.

This case reinforces the difficulty of diagnosing Bartonella sp. infection; this etiology must be considered even in patients with negative serology. The criteria for the diagnosis of bacterial endocarditis should contemplate a molecular positivity investigation for Bartonella spp, such as PCR in blood or serum samples as a major Duke criterion, even if with titers lower than 1 to 800.


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It doesn’t appear to me that endocarditis caused by Bartonella is rare.

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