Bartonella Endocarditis in a Pediatric Patient With Aortic Valvular Disease and Embolic Stroke: A Case Report and Review of the Literature.

Culture-negative endocarditis leading to embolic stroke is a rare clinical etiology in pediatrics. This is a case of a 12-year-old male with a history of bicuspid aortic valve and mild asymptomatic aortic stenosis who presented with flu-like symptoms, right-sided hemiplegia, and aphasia. Although he initially presented with symptoms of arterial ischemic stroke, he was found to have infective endocarditis (IE) secondary to Bartonella henselae, confirmed by echocardiogram and plasma microbial cell-free DNA (mcf-DNA) testing. Initial antimicrobial treatment per standard guidelines was unsuccessful. Hence, second-line antimicrobials were commenced, to which he responded appropriately. His clinical course markedly improved, with recovery of neurological function within three weeks. He continued treatment of endocarditis and bartonellosis in an outpatient setting with significant clinical response until eventual cardiac surgery for valve replacement. Although the diagnosis and management of blood culture-negative IE can be very challenging and associated with morbidity, mcf-DNA testing has been shown to be helpful in establishing an accurate diagnosis and promoting appropriate antimicrobial management.