Aggressive, culture-negative endocarditis with significant embolic complications and valve destruction can be caused by Neisseria gonorrhoeae. A recent case involved a 53-year-old man presenting with cardiac arrest and myocardial infarction, later found to have a heart murmur, a large mitral valve vegetation, and cerebral infarcts. Blood cultures were negative, but histopathology and universal PCR on valvular tissue identified N. gonorrhoeae.
Further questioning revealed multiple sexual partners, inconsistent STD screening, and limited barrier protection. This overlooked sexual history had diagnostic consequences. Gonococcal endocarditis, though rare, is highly virulent, leading to rapid valve damage and embolization, often necessitating surgery.
The case emphasizes the need to consider uncommon pathogens in aggressive or culture-negative endocarditis. Comprehensive sexual histories combined with advanced diagnostics like PCR are crucial for timely diagnosis and management.