Right-sided infective endocarditis complicated with aortic pseudoaneurysms and systemic embolism in a 27-year-old...

Infective endocarditis (IE) is one of the most frequent complications of ventricular septal defect (VSD) in adults, but is rarely associated with multiple systemic embolisms and aortic pseudoaneurysms. The authors report a case of a 27-year-old female known to have an asymptomatic neglected VSD. She was admitted to our unit with complaints of prolonged fever and chills. Physical examination detected hyperthermia at 38.7°C and pathognomonic holosystolic murmur detected by cardiac auscultation. Laboratory blood test showed evidence of acute staphylococcus infection and imaging investigations revealed perimembranous restrictive VSD, with vegetations exclusively present in the right heart ventricle, in addition to mycotic aneurysms on the aortic arch and multiple systemic embolis. A targeted antibiotic therapy was initiated along with an urgent heart surgery with a good evolution. This case showcases the need to look for systematically systemic embolism in endocarditis of the right ventricle (RV) associated with a communication of the right and left cavities, and the possibility of an eventual paradoxical embolism within VSD in case of an inverted right to left shunt. Furthermore, it highlights that congenital VSD can be the underlying condition of a severe endocarditis in case of acute staphylococcus bacteremia.