Homograft-related endocarditis caused by Bartonella henselae

We report on a 16-year-old boy seen 5 years after implantation of a homograft for correction of congenital heart disease (DORV). He presented with recurrent fever, his body temperature sometimes rising to 40 degrees C. Serology initially gave normal results, but eventually revealed elevated levels of antibodies against Bartonella. Echocardiography showed signs of florid endocarditis, such as vegetation of the homograft valve. He was treated with i.v, antibiotics and the homograft was exchanged. Bartonella henselae can cause culture-negative endocarditis, especially in persons who have pre-existing valve disease and have been exposed to cats.