Cor Vasa 2025, 67(Suppl.3):7-11 | DOI: 10.33678/cor.2024.109

Brucella prosthetic valve endocarditis: A case study

Hüseyin Döngelli^a, Ahmet Ünal^a, İsmail Eray Aygün^a, Ebru Özpelit^b, Mustafa Oktay Tarhan^a

^a Department of Internal Medicine, Dokuz Eylul University Hospital, Izmir, Turkey

^b Department of Cardiology, Dokuz Eylul University Hospital, Izmir, Turkey

Brucella bacteria are Gram-negative coccobacilli that typically cause brucellosis, presenting with nonspecific symptoms like fever, fatigue, and arthralgia. It is a multisystem disease that can lead to complications, with brucella endocarditis being the most common cardiovascular manifestation, though rare. Brucella endocarditis accounts for 80% of brucellosis-related deaths, often due to heart failure. The disease is primarily contracted through unpasteurized dairy products. Diagnosing brucellosis can be challenging due to its diverse clinical features. Brucella-related prosthetic valve endocarditis is particularly rare and presents unique diagnostic and treatment difficulties. We present a case report of brucella endocarditis in a male patient in his 50s. His medical history was insignificant except a history of mitral valve replacement due to acute rheumatic fever. He had a history of relapsing fever, night sweat and weight loss over a year. There were diverse laboratory findings such as elevated acute phase reactants, liver enzymes, hematuria, low c3/c4, positive antinuclear antibody and rheumatoid factor. During cardiac auscultation, a pansystolic murmur grade 2/6 was detected at the mitral focus, accompanied by the audible sound of a metallic prosthetic valve. Blood cultures from both arms were taken over four days. The first culture showed Gram-negative bacterial growth at 72 hours, prompting empirical treatment with cefepime and gentamicin. After 5 days, Brucella was identified, and the treatment was adjusted to doxycycline, rifampicin, and gentamicin. No growth was seen in cultures taken after starting empirical treatment. Subsequently, a transesophageal echocardiogram was performed, revealing a 13 mm vegetative mass consistent with prosthetic mitral valve vegetations. The patient then underwent surgery, and no complications were observed in the postoperative period.

Keywords: Brucella, Infective endocarditis, PET/CT, Stroke

Received: November 12, 2024; Revised: November 12, 2024; Accepted: December 28, 2025; Prepublished online: June 2, 2012; Published: September 1, 2025  Show citation