Diagnosis of infective endocarditis in a patient with sickle cell disease: case report

Authors

Keywords:

Endocarditis infecciosa; sicklemia; hemoglobinopatía; ecocardiografía; hemocultivos; vancomicina.

Abstract

Introduction: infective endocarditis remains a complex condition with high morbidity and mortality that requires early diagnosis and multidisciplinary management. In patients with hemoglobinopathies such as sickle cell trait, interactions between immunity, microvasculature, and infectious risk can modify the clinical presentation. Objective: to present a case of infective endocarditis in a patient with sickle cell disease. Case report: a 55-year-old mixed-race male with sickle cell trait and mild aortic regurgitation presented with chest pain radiating to the back and fever for one week (4 peaks/day, 38–40°C), headache, and a two-week dental abscess. Examination revealed a diastolic aortic murmur of III/VI intensity. ECG showed incomplete right bundle branch block. Abdominal ultrasound revealed a hypoplastic spleen. Complete blood count: hematocrit 0.22. Echocardiogram revealed an aortic valve mass (8.1 × 12 mm) consistent with a vegetation; Doppler showed moderate heart failure. No blood cultures were performed due to prior antibiotics. IV vancomycin was started; the fever resolved on the second day, and on day 15, the echocardiogram showed no residual mass. Conclusion: in patients with sicklemia, infective endocarditis can present with atypical febrile dynamics and diagnostic challenges; the need to optimize blood culture collection and the judicious use of imaging is reinforced.

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Author Biography

Annier Jesús Fajardo Quesada, Granma University of Medical Sciences. Manzanillo Faculty

CI:01010160908

References

1. Delgado V, Marsan NA, Waha S de, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis: Developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM). Eur Heart J [Internet]. 2023 [citado 03 Sep 2025];44(39):3948-4042. Disponible en: https://academic.oup.com/eurheartj/article/44/39/3948/7243107?login=true

2. Imazio M. The 2023 new European guidelines on infective endocarditis: recommendations and updates. J Cardiovasc Med (Hagerstown) [Internet]. 2024 [citado 03 Sep 2025];25(10):718-26. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11365601/pdf/jcarm-25-718.pdf

3. Hirosawa T, Sakamoto T, Hanai S, Harada Y, Shimizu T. Effect of Prior Antibiotic Treatment on Blood Culture in an Outpatient Department of General Internal Medicine: A Retrospective Case–Control Analysis. Int J Gen Med [Internet]. 2023 [citado 03 Sep 2025];16:2709-17. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10317762/pdf/ijgm-16-2709.pdf

4. DeSimone DC, Garrigos ZE, Marx GE, Tattevin P, Hasse B, McCormick DW, et al. Blood Culture–Negative Endocarditis: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases. J Am Heart Assoc [Internet]. 2025 [citado 03 Sep 2025];14:e040218. Disponible en: https://www.ahajournals.org/doi/epub/10.1161/JAHA.124.040218

5. Scourfield LEA, Nardo Marino A, Williams TN, Rees DC. Infections in sickle cell disease. Haematologica [Internet]. 2025 [citado 03 Sep 2025];110(3):1234-46. Disponible en: https://haematologica.org/article/view/11832

6. Opoku Asare B, Ntim OK, Awere Duodu A, Donkor ES. Sickle Cell Disease and Antimicrobial Resistance: A Systematic Review and Meta-Analysis. Infect Dis Rep [Internet]. 2025 [citado 03 Sep 2025];17(2):32. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12026643/pdf/idr-17-00032.pdf

7. Stavropoulou E, Monney P, Tzimas G, Ianculescu N, Tozzi P, Kirsch M, et al. Predictors of Persistent Fever Among Patients With Suspected Infective Endocarditis: Think Outside the box. Clin Infect Dis [Internet]. 2025 [citado 03 Sep 2025];80(4):795-803. Disponible en: https://academic.oup.com/cid/article/80/4/795/7909225

8. American College of Cardiology [Internet]. Washington D. C., Estados Unidos: American College of Cardiology Foundation; 2023 [citado 03 Sep 2025]. Delgado V, Marsan NA, Waha S de, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for Endocarditis-Ten Points. Disponible en: https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/20/49/2023-esc-guidelines-for-endocarditis-esc-2023

9. Kok W. Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal. Diagnostics (Basel) [Internet]. 2024 [citado 03 Sep 2025];14(4):1578-88. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11276044/pdf/diagnostics-14-01578.pdf

10. Ediap L, Córdova S, Zúñiga E, Usedo P, Muñoz A, Fernández G, et al . Endocarditis infecciosa asociada a catéter de hemodiálisis: hallazgos clínicos y ecocardiográficos. Rev Chil Cardiol [Internet]. 2017 [citado 03 Sep 2025];36(3):221-31. Disponible en: https://www.scielo.cl/pdf/rchcardiol/v36n3/0718-8560-rchcardiol-36-03-00221.pdf

11. Ladrón de Guevara D. Canelo A, Bitar P, Soto JR. Imágenes en endocarditis infecciosa: No todo es ecocardiografía. Rev. Chil. Infectol [Internet]. 2021 [citado 03 Sep 2025];38(2):260-70. Disponible en: https://www.scielo.cl/pdf/rci/v38n2/0716-1018-rci-38-02-0260.pdf

12. Enamorado Anaya AR, Yero García RO, Ruiz Manzanares A, Goro G, González Agüero M. Caracterización de pacientes con endocarditis infecciosa. Rev. cienc. méd. Pinar Río [Internet]. 2021 [citado 03 Sep 2025];25(3):e4909. Disponible en: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/4909/pdf

13. Dueñas García F, Conta López JA, Quintero Farías RA, Ospina-Díaz JM, Vargas-Rodríguez LJ. Caracterización de la endocarditis infecciosa. Rev. Colomb. Cardiol [Internet]. 2023 [citado 03 Sep 2024];30(2):78-85. Disponible en: http://www.scielo.org.co/pdf/rcca/v30n2/0120-5633-rcca-30-2-78.pdf

Published

2025-09-09

How to Cite

1.
Alonso Batista PM, Fajardo Quesada AJ, Sánchez Guerra JA. Diagnosis of infective endocarditis in a patient with sickle cell disease: case report. Revdosdic [Internet]. 2025 Sep. 9 [cited 2025 Oct. 8];8:e650. Available from: https://revdosdic.sld.cu/index.php/revdosdic/article/view/650

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Section

Case Report