A Rare Case of Bivalvular Infective Endocarditis and Mural Vegetation Caused by Bartonella quintana

Bartonella quintana is a rare but increasingly recognized cause of culture-negative infective endocarditis. We report a patient who presented with features of congestive heart failure without associated fever or detectable bacteremia. Diagnostic work-up revealed infective endocarditis due to B. quintana causing a large right atrial mural vegetation along with severe mitral regurgitation and severe aortic regurgitation, for which the patient had surgical valve replacements. The case highlights the indolent nature of the disease, leading to late presentation and challenging management, especially in a vulnerable patient population.