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Infective endocarditis due to Bartonella bacilliformis associated with…

- - - - Infections can trigger vasculitis through various direct (e.g., endothelium infection) or indirect (e.g., molecular mimicry) pathways.
      - Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of vasculitides that predominantly affect small vessels and cause systemic manifestations.
- - - - Physical examination
        
        Testing
        
        transthoracic echocardiogram showed perivalvular lesion in the right atrium, suggestive of vegetation
        
        The patient was admitted to the Cardiology ward with the probable diagnosis of atrial myxoma vs IE.
        
        Transesophageal echocardiography (TEE) revealed two masses, 10 × 18mm and 5 × 10mm, on the lateral wall of the right atrium (Figure 1).
        
        transferred to the Infectious Diseases ward --> Negative repeat aerobic and anaerobic blood cultures, peripheral smear for malaria, serology testing for Brucella and Salmonella, bone marrow culture, and enzyme-linked immunosorbent assay (ELISA) test for human immunodeficiency virus, all of which resulting negative.
        
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        Blood testing
        
        9.26 × 103 leukocytes/μl
        
        lymphopenia (0.84 × 103 lymphocytes/μl)
        
        neutrophilia (7.72 × 103 neutrophils/μl)
        
        0.09 × 103 eosinophils/μl
        
        thyroid-stimulating hormone level of 22.7μUI/ml
        
        creatinine of 0.82mg/dl.
        
        normocytic, normochromic anemia (11.1g/dl),
        
        Blood and urine cultures negative
        
        Normal ECG
        
        Febrile at 39°C
        
        Hypothyroid facies: thick skin, periorbital edema, and mucosal thickening with dysphonia
        
        mesosystolic murmur on the tricuspid area.