A Case of Pulmonary Artery Endarteritis With Patent Ductus Arteriosus

Right-sided heart endocarditis contributes to a small portion of infective endocarditis (IE) cases. Right-sided endocarditis related to undiagnosed congenital heart defects is even more scarce. Prompt diagnosis by transthoracic echocardiography (TTE), aggressive antibiotics from the beginning, and surgical removal of the vegetation for IE help prevent the risk of multi-organ failure and fatal pulmonary embolism. This is a case of a 38-year-old female, with normal medical history and recent vaginal birth at a district hospital four months ago. She was admitted to the hospital because of fever and continuous shortness of breath one month before admission. TTE detected vegetation (10x23 mm) on the left pulmonary artery and patent ductus arteriosus. A CT scan showed several abnormal mobile mixed-echo masses in the left pulmonary artery and partial pulmonary embolism. The patient had surgery to remove the vegetation and close the patent ductus arteriosus. The patient was stable after surgery and discharged two weeks after surgery. She continued two-week oral antibiotics at home and made a follow-up appointment one month later. Pulmonary artery endarteritis associated with patent ductus arteriosus is a rare lesion and has a high risk of death. The diagnosis should be considered in any febrile, septic patient with congenital heart disease. Removing vegetation and aggressive antibiotic treatment should be performed together to improve the outcome.