Diagnosis of infective endocarditis in a patient with sickle cell disease: case report
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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Copyright (c) 2025 Pedro Miguel Alonso Batista; Annier Jesús Fajardo Quesada; José Alberto Sánchez Guerra

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