A Rare Case of Pediatric Infective Endocarditis Initially Presenting as Meningitis in a Previously Healthy Child

Area of Science:

• Pediatric Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Infective endocarditis (IE) is a rare but severe condition in children, posing significant risks especially in those without pre-existing cardiac conditions.
• Delayed diagnosis of pediatric IE can result in severe systemic complications, increasing morbidity and mortality.

Observation:

• A previously healthy eight-year-old girl was initially misdiagnosed with bacterial meningitis.
• Despite antibiotic treatment, she developed multiple septic embolic events, including cerebral, splenic, and renal infarctions, and digital gangrene.
• Serial echocardiograms identified mitral valve vegetation and an aortic root abscess, with blood cultures confirming methicillin-sensitive Staphylococcus aureus (MSSA).

Findings:

• The patient underwent successful surgical management using a modified Ross procedure.
• A six-week course of intravenous flucloxacillin contributed to her full recovery.
• The case highlights the diagnostic challenges associated with pediatric IE in healthy children.

Implications:

• This case emphasizes the importance of considering IE in pediatric patients presenting with non-specific symptoms, even without cardiac risk factors.
• Serial imaging, prompt multidisciplinary collaboration, and timely surgical intervention are critical for managing pediatric infective endocarditis.
• Successful treatment underscores the effectiveness of combined surgical and antibiotic approaches in complex pediatric IE cases.