Blood culture-negative infective endocarditis with thalassemia and neurological complication: A dangerous combination

Infective endocarditis (IE) is a life-threatening systemic disease that mostly affects people with valvular heart disease, prosthetic valves, or intracardiac devices. Infective endocarditis is a dangerous cardiac involvement in thalassemia patients. Thus, a multidisciplinary approach is important to provide efficient and effective therapy.

A 31-year-old man came to our tertiary referral hospital complaining of right-side paralysis of the body and slurred speech. Vital signs were normal. There were grade III/VI systolic murmurs from chest examination in midclavicular line intercostal space V sinistra. Head CT scan without contrast showed an embolic event. Peripheral blood smear showed iron deficiency anemia. Further electrophoresis hemoglobin (Hb) examination showed HbE-pathy. Echocardiography showed vegetations on the anterior and posterior mitral leaflet, leading to severe mitral regurgitation (MR). Blood culture examinations showed no bacterial growth. The patient was then diagnosed with severe MR due to possible IE, acute stroke infarction, and HbE thalassemia. The patient was treated with optimal medical therapy because he refused surgery. After six months of follow up, patients were found dead at his house

Thalassemia is a risk factor for infective endocarditis. Both are a dangerous combination, and early recognition should be made carefully to prevent worse outcome.