A rare case of infective endocarditis in an immunocompetent patient

Abstract

Infective endocarditis is a relatively rare disease, but with a significant impact. Staphylococcus aureus, Coagulase-negative staphylococci and oral streptococci are commonly causative organism. Mycobacterium tuberculosis or non-tuberculous mycobacteria are very rare etiology of infective endocarditis. Here, we report a case of tuberculosis of hematopoietic organs and tuberculous endocarditis in an immunocompetent patient. A 32-year-old man was hospitalized for a 15-day-history of persistent fever, asthenia, anorexia and diarrhea. His laboratory investigations showed elevated inflammatory markers and pancytopenia. All investigations, even sputum smear was negative for acid-fast bacilli. Thoracoabdominal computed tomography showed abdominal lymph nodes with a slight pleural and peritoneal effusion. Transthoracic echocardiography revealed a 25 mm mobile vegetation on the large mitral valve. Blood cultures were negative. The serological testing for Coxiella burnetii, Bartonella quintana, Bartonella henselae, Brucella species and Legionella species were negative, as well. Bone marrow biopsy showed tuberculosis of hematopoietic organs. The patients received antitubercular therapy for a 15-month-duration. The disease evolution was favourable. The echocardiography showed no vegetation after 70 days therapy. Tuberculous endocarditis should be bearded in mind, especially in endemic countries. An early diagnosis followed by the adequate antitubercular treatment might avoid serious complications and death.