INFECTIVE ENDOCARDITIS IN PATIENT WITH PATENT DUCTUS ARTERIOSUS AND PNEUMONIA
Rien Anggraini Razak,Willis Kwandou,Firdaus Fabrice Hannanu,Julius Patimang
Awal Bros Hospital Makassar Siloam Hospital Makassar Hasanuddin University
Background : The lack of spesific clinical manifestation and rare occurence of infective endocarditis (IE) make it oftentimes difficult to be established. In our report, the initial diagnosis was blurred by the presence of pneumonia, since patent ductus arteriosus (PDA) could be a risk factor of both. A comprehensive investigation and appropriate treatment are necessary to effectively treat the patient and to reduce further risk of complications.
Case Presentation Summary : A 10-year-old girl presented with shortness of breath, fever, cough, and previous history of PDA. Rhonchi and continuous murmur were found on chest auscultation. Laboratory and radiologic results were supportive for pneumonia, and the patient was initially treated with ceftriaxone but showed no significant recovery. Evaluation of PDA using transthoracic echocardiogram (TTE) reported an incidental finding of IE vegetations on pulmonary artery, confirmed by positive blood cultures. After the antibiotic was replaced to meropenem which was sensitive to the causative agents, the vegetations were subsided. The patient was discharged afterwards and remains well after 6 weeks of follow up.
Learning Points/Discussion : We reported a case of a 10-year-old girl with IE with initial presentation of pneumonia and histroy of PDA. Signs of infection (fever and elevated leucocytes) were directed to pneumonia, until IE was established in TTE and blood cultures. Vegetations at pulmonary artery were uncommon (only 5-10% of all IE cases) but were anatomically reasonable in our case because of the presence of PDA. Blood cultures were positive for Staphylococcous sp. and Streptococcus sp., the two most common bacteria reported causing IE. In this case, we managed to get our hands to sensitive antibiotic and she was recovered with no signs of emboli nor other complications.