Bicuspid Aortic Valve Endocarditis Caused by Burkholderia Cepacia in an Immunocompetent Patient: A Rare Case Report

Abstract

Background: Infectious endocarditis (IE) refers to pyogenic inflammation of the endocardium, typically involving heart valves. Although rare, IE can sometimes be caused by Burkholderia cepacia complex. The affected patients are usually high-risk populations, including IV drug users and patients with prosthetic valves. Infections in immunocompetent patients with no conventional risk factors, as reported in this case, are highly uncommon. Case Summary: We present a case of a 35-year-old male patient who presented with a three-week history of high-grade, intermittent fever. The patient had maxillofacial surgery for facial trauma resulting from a road traffic accident 4 months ago, with no evidence of post-surgical infections or other complications. On examination, the patient was febrile, had an early diastolic blowing murmur over the aortic area, and no peripheral stigmata of IE. Further workup revealed elevated inflammatory markers and increased D-dimer levels. Echocardiography identified a congenital bicuspid aortic valve (Sievers type 2) with a small mobile vegetation and mild-to-moderate aortic regurgitation. Diagnosis of B. cepacia-caused IE was made following the blood cultures report, as per the updated 2023 Duke-ISCVID criteria. Despite culture-directed therapy, the patient's clinical course was complicated by persistent fevers, inflammatory responses, and an embolic stroke, necessitating surgical intervention. Following valve replacement surgery, he remained clinically stable. Conclusion: Burkholderia cepacia is a highly uncommon but significant cause of IE, especially in patients with pre-existing abnormalities like prosthetic valves and congenital valvular deformities. Standard therapeutic guidelines remain lacking due to the rarity of its occurrence. Due to its high inherent antimicrobial resistance and possible embolic complications, clinicians should maintain high vigilance for its nosocomial spread. Management requires a quick, interdisciplinary approach, culture-based antibiotic therapy, and prompt surgical intervention, if necessary. Key Words: Bicuspid Aortic Valve, Endocarditis, Burkholderia.