A case report of Bartonella endocarditis with pancytopenia

A 9-year-old male with history of complex congenital heart disease presented with intermittent fevers and chills of 3-month duration along with pancytopenia. Given a high suspicion of endocarditis despite negative blood cultures, a literature search for culture-negative endocarditis yielded the possibility of less common organisms, including zoonotic agents. There were only isolated case reports of Bartonella causing pancytopenia. Further testing revealed positive Bartonella henselae by DNA PCR in the patient who was treated with an antibiotic regimen consisting of doxycycline, Bactrim, and rifampin and ultimately had the homograft removed. Given the rarity of Bartonella endocarditis, ∼3% of all endocarditis,1, 2 and the additional testing necessary for diagnosis, one must consider this possible diagnosis with a high index of suspicion.