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Prosthetic valve endocarditis is an uncommon manifestation of infection with Bartonella species. Herein, we report a case of Bartonella henselae endocarditis involving prosthetic mitral and aortic valves. The patient had a favorable outcome with combined medical and surgical therapy. Concomitant crescentic glomerulonephritis led to an initial mistaken diagnosis of Wegener's granulomatosis. CASE REPORTA 43-year-old Caucasian male with underlying mitral valve prolapse was diagnosed with culture-negative endocarditis involving his mitral and aortic valves in 1999. He required the placement of an aortic homograft and porcine mitral valve; 6 weeks of parenteral antimicrobial therapy was subsequently administered (details unknown). An etiology for his endocarditis was apparently never established by either blood or excised-valve cultures. He remained in good health after surgery.In August 2005, the patient presented with increasing fatigue and intermittent fevers. Blood cultures were negative, and a transthoracic echocardiogram showed no abnormalities. A transesophageal echocardiogram (TEE) done for persistent fevers (October 2005) showed no evidence of endocarditis. He subsequently developed gross hematuria; cystoscopy results were within normal limits.In November 2005, he again presented with worsening fatigue, ongoing fevers, and acute renal insufficiency. A TEE revealed a 1.5-by-0.5-cm vegetation on the porcine mitral valve and thickening of the aortic valve homograft. The results of a renal biopsy were consistent with focal segmental crescentic glomerulonephritis (GN). In addition, laboratory studies revealed proteinase 3-specific antineutrophil cytoplasmic antibodies (PR3-ANCA). Therapy with prednisone and cyclophosphamide was initiated for a presumptive diagnosis of Wegener's granulomatosis. Antimicrobial therapy with ceftriaxone, doxycycline, and daptomycin was also initiated for culture-negative endocarditis. He was transferred to a tertiarycare medical center, where multiple sets of blood cultures did not reveal any growth. The following laboratory tests were negative: serology tests for Legionella spp., Coccidioides immitis, Q fever, Whipple's disease, Mycoplasma pneumoniae, and human immunodeficiency virus; a Cryptococcus neoformans antigen test; and a PCR test for Brucella spp. Chlamydia and Chlamydophila spp. serology tests were positive (concentrations of immunoglobulin G [IgG] for Chlamydophila pneumoniae, Chlamydia trachomatis, and Chlamydophila psittaci in serum, Ͼ1:256). Bartonella spp. serology analyses were not performed. The patient was treated with ceftriaxone, doxycycline, and rifampin for 6 weeks. Prednisone and cyclophosphamide were discontinued when immunofluorescence studies revealed a pauci-immune pattern not consistent with Wegener's granulomatosis.Fevers recurred immediately after the completion of antimicrobial therapy (end of December 2005). The patient was transferred to our institution for further evaluation in February 2006. Upon admission, a cardiovascular exam disclosed an atria...

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A previously healthy 49‐year‐old male patient presented with COVID‐19 infection and required mechanical ventilation and extracorporeal membrane oxygenation due to severe hypoxemia. Echocardiography showed cardiac dysfunction with an apical sparing strain pattern, which rapidly normalized within a week. Apical sparing myocardial strain in patients with COVID‐19 infection may suggest reverse‐type stress cardiomyopathy.