Fatal Brucella Endocarditis in a Middle-Aged Male: Lessons on Diagnostic and Therapeutic Challenges

Infective endocarditis is a serious infection of the endocardium of the heart, particularly the valves. It continues to carry poor prognosis despite advances in both diagnostic and therapeutic procedures. Blood culture remains the gold standard on diagnosis; however, noticeably blood culture–negative IE (BCNIE) accounts for a third of IE cases. Brucella spp., a zoonotic infectious species, is among recognized causes of BCNIE, which carries higher morbidity and mortality risks if not treated early. A 53-year-old male, seen after being partially treated for brucellosis, has presented with acute decompensated heart failure and fever. He was diagnosed, based on echocardiography and standard agglutination test (SAT), with Brucella IE with aortic and mitral incompetency. Unfortunately, the patient had tortuous hospitalization course, failed to respond to emergent double valve replacement, and died despite all supportive measures. In this case, we describecomplicated and fatal brucellosis with endocarditis and severe aortic and mitral valve incompetency. Brucella endocarditis is rare, yet can be a lethal condition if not treated promptly. In presence of complications, early surgical intervetion may be considered.