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A transthoracic echocardiogram demonstrated an abnormality on the mitral valve. Operative evaluation revealed a purulent mitral valve with vegetative clumps. Cultures of the vegetation and the blood grew no organisms. BCNE is a rare entity; neurological abnormalities may be the only presenting signs\/symptoms. Endocarditis should be considered among the causes of altered mental status, even in the absence of positive blood cultures.<\/jats:p>","DOI":"10.1136\/bcr-2018-224707","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T06:55:55Z","timestamp":1535007355000},"page":"bcr-2018-224707","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Blood culture-negative endocarditis presenting as altered mental status"],"prefix":"10.1136","volume":"2018","author":[{"given":"Joshua R","family":"Dilley","sequence":"first","affiliation":[{"name":"Family and Community Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1123-5342","authenticated-orcid":false,"given":"Charles R","family":"Clinch","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,8,23]]},"reference":[{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.10.044"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.1.177-207.2001"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmal.2014.11.003"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-008-0046-3"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.5","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.44.1.257-259.2006"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2007.07.029"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv319"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.8","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s12574-015-0242-8","article-title":"Infective endocarditis with negative blood culture and negative echocardiographic findings","volume":"13","author":"Sumatani","year":"2015","journal-title":"J Echocardiogr"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.9","first-page":"89","article-title":"[Neurologic complications of infective endocarditis: do they have an impact on prognosis?]","volume":"77","author":"Pigretti","year":"2017","journal-title":"Medicina"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.21.5.695"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000296"},{"key":"2025082701512303000_2018.aug20_2.bcr-2018-224707.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.07.023"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:51:34Z","timestamp":1756284694000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,23]]},"references-count":12,"alternative-id":["10.1136\/bcr-2018-224707"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224707","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,23]]}}}