Bacterial endocarditis in a child with haemophilia B: risks of central venous catheters

Area of Science:

• Pediatric Hematology
• Infectious Diseases
• Cardiology

Background:

• Central venous catheters (CVCs) are essential for managing chronic conditions but carry risks of thrombosis and infection.
• Factor IX deficiency (hemophilia B) requires careful management, often involving prophylactic treatment.
• Needle phobia can significantly impact treatment adherence in pediatric patients.

Observation:

• A 5-year-old boy with factor IX deficiency and needle phobia received a portacath due to poor compliance with prophylactic treatment.
• He developed a Staphylococcus aureus line infection within a week, treated with intravenous antibiotics.
• A month later, recurrent S. aureus bacteremia led to the diagnosis of bacterial endocarditis with a tricuspid valve vegetation and pulmonary emboli.

Findings:

• The case highlights the potential for CVC-related infections to progress to severe systemic complications like endocarditis and thromboembolism.
• Staphylococcus aureus was identified as the causative agent in both the line infection and the subsequent endocarditis.
• Echocardiography was crucial in diagnosing the endocardial vegetation and assessing the extent of cardiac involvement.

Implications:

• This case underscores the importance of vigilant monitoring for CVC-related infections, especially in immunocompromised or chronically ill children.
• Early recognition and aggressive antibiotic therapy are critical for managing CVC-associated endocarditis and its complications.
• Alternative strategies for managing needle phobia and ensuring treatment adherence in pediatric patients with hemophilia should be considered.