[Pulmonary septic embolism with right side infectious endocarditis and ventricular septal defect: a case report]

An 18-year-old man was diagnosed with ventricular septal defect after birth. He was asymptomatic until February 2006. He came to our hospital with remittent fever persisting for 2 months. Chest computed tomography showed multiple infiltrative shadows and alpha-streptococcus was detected on blood cultures. Transesophageal echocardiography detected vegetation (1.3 cm) on the right ventricle wall at the point of impact of the shunted bloodstream. We diagnosed pulmonary septic embolism and began to administer penicillin G and gentamicin. Sixteen days later, a new pulmonary septic embolism appeared, so antibiotic treatment was continued at a higher dose. Two weeks later, the vegetation and infiltrative shadow disappeared. Echocardiography showed the ratio of pulmonary to systemic blood flow was 1.2. These findings indicate that patch closure of ventricular septal defect may be necessary for prevention of recurrence of right side infectious endocarditis.