Abstract
Culture-negative endocarditis has long been associated with systemic lupus erythematosus, but is usually asymptomatic or involves a single valve. We present a patient with destructive culture-negative endocarditis that remains without a microbial etiology despite an exhaustive workup using advanced diagnostic techniques in a patient with systemic lupus erythematosus.
Highlights
Culture-negative endocarditis (CNE) is known by many names including marantic endocarditis (ME), non-bacterial thrombotic endocarditis, verrucous endocarditis, and Libman-Sacks vegetations in collagen vascular diseases, systemic lupus erythematosus (SLE)
Our patient had no evidence of active infection prior to admission, and a subsequent workup including extended culture duration, serologies, histopathological examination, and polymerase chain reaction (PCR) did not reveal a microbial etiology despite the degree of purulent destruction
The reasons for culture negativity are related to technical limitations of culture or to the specific organism, though HACEK group bacteria - formerly considered a common cause of culture-negative endocarditis - are usually isolated within 5 days with current blood culture systems [5,6,7]
Summary
Culture-negative endocarditis (CNE) is known by many names including marantic endocarditis (ME), non-bacterial thrombotic endocarditis, verrucous endocarditis, and Libman-Sacks vegetations in collagen vascular diseases, systemic lupus erythematosus (SLE). We present the case of a woman with SLE admitted for an elective mitral valve repair who was found to have mitral and aortic valve culture-negative vegetations with atrial destruction. Case Presentation A 42 year old woman with SLE for the past 12 years and end stage renal disease requiring peritoneal dialysis was admitted to the hospital for congestive heart failure. Her SLE was controlled on hydroxychloroquine and prednisone 10 mg daily for the past 5 years. Gram stain of the valvular tissue demonstrated no white blood cells and no organisms; cultures for bacteria (retained for 14 days), fungi and mycobacteria were all negative. Immuno-histochemistry for Bartonella species and C. burnetii were negative
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