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PMID- 29390335
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Fever of unknown origin and splenomegaly: A case report of blood culture negative
      endocarditis.
PG  - e9197
LID - 10.1097/MD.0000000000009197 [doi]
AB  - RATIONALE: Fever of unknown origin (FUO) can be determined by different
      conditions among which infectious diseases represent the main cause. PATIENT
      CONCERNS: A young woman, with a history of aortic stenosis, was admitted to our
      unit for a month of intermittent fever associated with a new diastolic heart
      murmur and splenomegaly. Laboratory tests were negative for infectious screening.
      The total body computed tomography (CT) scan excluded abscesses, occulted
      neoplasia, or lymphadenopathy. DIAGNOSES: The transthoracic and transesophageal
      echocardiogram showed an aortic valve vegetation. Three sets of blood cultures
      were negative for all microorganisms tested. According to these findings,
      Bartonella endocarditis was suspected and the serology tests performed were
      positive. Finally, real-time polymerase chain reaction (RT-PCR) detected
      Bartonella henselae DNA on tissue valve. INTERVENTIONS: The patient underwent
      heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral
      Doxycycline was prescribed for 16 days and, successively, with Doxycycline and
      Ceftriaxone for 6 weeks. OUTCOMES: After surgery and antibiotic therapy, patient 
      continued to do well. LESSONS: Bartonella species are frequently the cause of
      negative blood culture endocarditis. Molecular biology techniques are the only
      useful tool for diagnosis. Valvular replacement is often necessary and antibiotic
      regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as
      treatment.Echocardiogram and blood cultures must be performed in all cases of
      FUO. When blood cultures are negative and echocardiographic tools are indicative,
      early use of Bartonella serology is recommended.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Burzo, Maria Livia
AU  - Burzo ML
AD  - Institute of Internal Medicine.
FAU - Antonelli, Mariangela
AU  - Antonelli M
AD  - Institute of Internal Medicine.
FAU - Pecorini, Giovanni
AU  - Pecorini G
AD  - Institute of Internal Medicine.
AD  - Laboratory of Vascular Biology and Genetics, Catholic University of the Sacred
      Heart, Fondazione University Hospital A. Gemelli, Rome, Italy.
FAU - Favuzzi, Angela M R
AU  - Favuzzi AMR
AD  - Institute of Internal Medicine.
FAU - Landolfi, Raffaele
AU  - Landolfi R
AD  - Institute of Internal Medicine.
FAU - Flex, Andrea
AU  - Flex A
AD  - Institute of Internal Medicine.
AD  - Laboratory of Vascular Biology and Genetics, Catholic University of the Sacred
      Heart, Fondazione University Hospital A. Gemelli, Rome, Italy.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
SB  - AIM
SB  - IM
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Cat-Scratch Disease/*diagnosis/drug therapy/surgery
MH  - Combined Modality Therapy
MH  - Diagnosis, Differential
MH  - Echocardiography
MH  - Endocarditis, Bacterial/*diagnosis/drug therapy/surgery
MH  - Female
MH  - Fever of Unknown Origin
MH  - Humans
MH  - Middle Aged
MH  - Real-Time Polymerase Chain Reaction
MH  - Splenomegaly
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009197 [doi]
AID - 00005792-201712150-00085 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9197. doi: 10.1097/MD.0000000000009197.