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[Isolated infective endocarditis of pulmonary valve in patient with interventricular septal defect]
V Lagarto1, S Cabral, F Oliveira
1Serviço de Cardiologia do Hospital Geral de Santo António, Porto.
Abstract:
A case of isolated infective endocarditis of the pulmonary valve in a patient with known subpulmonary interventricular septal defect that had, as major complication pulmonary septic embolization, was reported by the authors. The disease followed an insidious course, diagnosed by the presence of vegetations in the echocardiogram, some of them larger than 1 cm. They were found in the right ventricular infundibulum and in the pulmonary valve leaflets. The isolation of Estreptococcus viridans in blood cultures has confirmed the diagnosis. In spite of appropriate antimicrobial therapy, according to the antibiogram data (with Ampicillin and Gentamicin), fever lasted for more than three weeks. This event suggested medical treatment failure and the possibility of surgery was considered. However, the endocarditis eventually healed with medical therapy alone, and this unusual course with prolonged fever was presumed to be caused by lung metastatic infection secondary to septic embolization. This complication is relatively common, but lung involvement is usually a subclinical event, not responsible for such persistent fever, as happened in the case now reported. We emphasize the rarity of this case, the unusual clinical course and the discussion concerning the therapeutic options.
Insights
This case report details rare isolated infective endocarditis of the pulmonary valve, complicated by septic embolization. Despite prolonged fever, the patient successfully healed with medical therapy alone.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Case Reports
Background:
- Subpulmonary interventricular septal defect predisposes to specific cardiac complications.
- Infective endocarditis typically affects left-sided valves but can occur on the pulmonary valve.
Observation:
- A patient with a subpulmonary interventricular septal defect developed isolated pulmonary valve endocarditis.
- Echocardiography revealed large vegetations ( > 1 cm) in the right ventricular infundibulum and pulmonary valve.
- Blood cultures identified Streptococcus viridans, confirming the diagnosis.
Findings:
- The patient experienced prolonged fever (>3 weeks) despite appropriate antimicrobial therapy (Ampicillin and Gentamicin).
- Pulmonary septic embolization was a major complication, likely causing persistent fever.
- Endocarditis ultimately resolved with medical management, avoiding surgery.
Implications:
- This case highlights the rarity of isolated pulmonary valve endocarditis and its unusual protracted clinical course.
- It underscores the importance of considering metastatic lung infection in persistent fever post-endocarditis diagnosis.
- The successful medical management challenges assumptions about surgical necessity in complex endocarditis cases.