ArticleJACC. Case reports2025
Lightning Flash Unveiling Bartonella Endocarditis: An Approach to Diagnosing and Managing Culture-Negative Infective Endocarditis.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCulture-negative infective endocarditis (CNIE) poses diagnostic challenges owing to the absence of pathogen identification through standard blood cultures. CASE SUMMARY: A 43-year-old man who was lost to follow-up after recent myocardial infarction due to embolic event requiring balloon angioplasty presented with acute left-sided weakness. Brain magnetic resonance imaging revealed embolic infarctions, and echocardiography identified large, mobile vegetations with moderately severe aortic regurgitation. Empiric antibiotics were started, and blood cultures were negative. The Penumbra Lightning Flash system was used for vacuum-assisted aspiration of vegetations under intracardiac echocardiography guidance. Polymerase chain reaction analysis of aspirated material identified Bartonella species, allowing targeted antibiotic therapy with doxycycline and gentamicin. The patient showed clinical improvement, with a significant reduction in vegetation burden. DISCUSSION: This case demonstrates the utility of vacuum-assisted aspiration for vegetation debulking and pathogen identification in CNIE, particularly in high-risk patients. It highlights the importance of molecular diagnostics and multidisciplinary management in improving outcomes. TAKE-HOME MESSAGE: Vacuum-assisted aspiration is an effective diagnostic and therapeutic option for CNIE, particularly in cases with large vegetations and high surgical risk.
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