Bicuspid Aortic Valve Endocarditis and Q Fever

Sara J King; Katherine V Trinh; Masataka Kawana

doi:10.1016/j.jaccas.2025.103771

Bicuspid Aortic Valve Endocarditis and Q Fever

JACC Case Rep. 2025 Jun 18;30(15):103771. doi: 10.1016/j.jaccas.2025.103771.

Authors

Sara J King¹, Katherine V Trinh², Masataka Kawana²

Affiliations

¹ Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: sjnking@stanford.edu.
² Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.

Abstract

Background: Patients with bicuspid aortic valves (BAVs) are at increased risk of infective endocarditis. Coxiella burnetii is a rare cause of culture-negative infective endocarditis.

Case summary: A young male with BAV presented with 3 months of fevers and abdominal distension. Initial workup showed pancytopenia and massive splenomegaly. Blood cultures were negative. Echocardiography revealed endocarditis of the bicuspid valve, aortic regurgitation, and aortic pseudoaneurysm. He underwent annulus debridement, valve replacement, and concurrent splenectomy. Serologic and tissue studies revealed C burnetii and Q fever.

Discussion: Chronic Q fever is a clinical syndrome that presents months to years after C burnetii infection with nonspecific symptoms. Due to its intracellular and fastidious nature, treatment requires a prolonged antibiotic course and standard surgical indications for infective endocarditis.

Take-home message: Patients with BAVs are at increased risk of endocarditis, and C burnetii should be considered in all cases of culture-negative endocarditis.

Keywords: Q fever; bicuspid; culture-negative; endocarditis.

Publication types

Case Reports