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Case Records of the Massachusetts General Hospital
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Volume 356:715-725 February 15, 2007 Number 7
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Case 5-2007 — A 53-Year-Old Man with a Prosthetic Aortic Valve and Recent Onset of Fatigue, Dyspnea, Weight Loss, and Sweats
Didier Raoult, M.D., Suhny Abbara, M.D., Davinder S. Jassal, M.D., and Richard L. Kradin, M.D.

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Presentation of Case

Dr. Julie E. Myers (Department of Medicine): A 53-year-old man with a prosthetic aortic valve was admitted to this hospital because of the recent onset of fatigue, dyspnea, weight loss, and sweats.

Approximately 4 years earlier, severe aortic insufficiency had developed. Echocardiography revealed a calcified, bicuspid aortic valve. Aortic-valve replacement was performed elsewhere, with a Medtronic Hall tilting-disk valve. Three months later, aortic insufficiency recurred, and the aortic valve was replaced with another Medtronic Hall valve at the same hospital. During the second operation, there was partial dehiscence of the prosthesis along a portion of the annulus, and although there . . . [Full Text of this Article]

Differential Diagnosis

Causes of Culture-Negative Endocarditis

Infection with C. burnetii

            Infection with Bartonella Species

            Less Common Causes of Culture-Negative Endocarditis

Diagnosis of Culture-Negative Endocarditis

Clinical Diagnosis

Dr. Didier Raoult's Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Department of Clinical Microbiology, Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseilles, France (D.R.); the Departments of Radiology (S.A.), Cardiology (D.S.J.), and Pathology (R.L.K.), Massachusetts General Hospital, Boston; and the Departments of Radiology (S.A.), Medicine (D.S.J.), and Pathology (R.L.K.), Harvard Medical School, Boston.



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