The Importance of Systemic Symptoms in Endocarditis

Culture negative endocarditis can be caused by Bartonella, Coxiella or lupus. The lack of systemic features make me step back and say, could this vegetation with this propensity to leave the valve,. Could it be a malignancy, an occult malignancy in the background? And is this maryantic endocarditis? I doubt limbinsacs, because it would be odd for someone like this individual to have lupus."