{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T04:03:51Z","timestamp":1770264231871,"version":"3.49.0"},"reference-count":41,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,5]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    Cat scratch disease (CSD), caused by\n                    <jats:italic>Bartonella henselae<\/jats:italic>\n                    , is an uncommon cause of fever of unknown origin (FUO) and rarely presents with visceral organ involvement. This case report describes a middle-aged woman with 3\u2009months of night sweats and 1\u2009month of fevers. Initial workup showed elevated inflammatory markers, multiple splenic lesions and a pelvic fluid collection. A detailed history noted that she recently adopted a stray kitten, prompting\n                    <jats:italic>Bartonella<\/jats:italic>\n                    serological testing. Given the atypical presentation, a broad infectious evaluation was also pursued, including testing for mycobacterial, fungal and other bacterial pathogens. When\n                    <jats:italic>B. henselae<\/jats:italic>\n                    IgG titre returned strongly positive and transoesophageal echocardiogram (TEE) showed a tricuspid valve vegetation, the diagnosis of culture-negative endocarditis was established. Treatment with doxycycline and rifampin led to rapid symptom resolution.\n                  <\/jats:p>\n                  <jats:p>\n                    This case highlights the potential for CSD to present as right-sided endocarditis. Clinicians should consider\n                    <jats:italic>B. henselae<\/jats:italic>\n                    infection in patients with FUO and cat exposure, even without classic regional lymphadenopathy. Due to its fastidious nature,\n                    <jats:italic>B. henselae<\/jats:italic>\n                    often evades culture, underscoring the role of serological or molecular testing in diagnosis. This report emphasises the diagnostic challenges of culture-negative endocarditis and the critical importance of detailed exposure history in guiding targeted diagnostic testing and stepwise serological evaluation in atypical disease patterns.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-268764","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T14:55:52Z","timestamp":1770216952000},"page":"e268764","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Bartonella henselae<\/i>\n                    tricuspid valve endocarditis presenting as fever of unknown origin"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9420-0905","authenticated-orcid":false,"given":"Zo\u00eb","family":"Wohlgenant","sequence":"first","affiliation":[{"name":"Infectious Diseases Division, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Hansen","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2635-6473","authenticated-orcid":false,"given":"Molly","family":"McDonough","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Cutshaw","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"2026020406552165000_19.2.e268764.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-5520(05)70414-1"},{"key":"2026020406552165000_19.2.e268764.2","doi-asserted-by":"crossref","DOI":"10.1155\/2011\/183937","article-title":"Systemic Bartonella henselae Infection in Immunocompetent Adult Presenting as Fever of Unknown Origin","volume":"2011","author":"Zenone","year":"2011","journal-title":"Case Rep Med"},{"key":"2026020406552165000_19.2.e268764.3","doi-asserted-by":"publisher","DOI":"10.1086\/432934"},{"key":"2026020406552165000_19.2.e268764.4","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.3201\/eid2607.200034","article-title":"Atypical Manifestations of Cat-Scratch Disease, United States, 2005-2014","volume":"26","author":"Nawrocki","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2026020406552165000_19.2.e268764.5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad271"},{"key":"2026020406552165000_19.2.e268764.6","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.amjmed.2015.06.001","article-title":"Fever of unknown origin: a clinical approach","volume":"128","author":"Cunha","year":"2015","journal-title":"Am J Med"},{"key":"2026020406552165000_19.2.e268764.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2111003"},{"key":"2026020406552165000_19.2.e268764.8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00114810"},{"key":"2026020406552165000_19.2.e268764.9","doi-asserted-by":"crossref","DOI":"10.1128\/cmr.00019-23","article-title":"Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management","volume":"36","author":"Thompson","year":"2023","journal-title":"Clin Microbiol Rev"},{"key":"2026020406552165000_19.2.e268764.10","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1056\/NEJMra2306821","article-title":"Coccidioidomycosis and Histoplasmosis in Immunocompetent Persons","volume":"390","author":"Galgiani","year":"2024","journal-title":"N Engl J Med"},{"key":"2026020406552165000_19.2.e268764.11","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens12081027","article-title":"Updates in Culture-Negative Endocarditis","volume":"12","author":"McHugh","year":"2023","journal-title":"Pathogens"},{"key":"2026020406552165000_19.2.e268764.12","unstructured":"Centers for disease control and prevention . 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