Commando Surgery in Infective Endocarditis by Streptococcus gallolyticus in an Adolescent: A Rare Case Report

Infective endocarditis (IE) is a significant cause of morbidity and mortality in India, particularly in children with underlying congenital heart disease (CHD). While the global incidence of pediatric IE remains low, developing countries like India face a higher burden due to delayed diagnosis, inadequate access to specialized cardiac care, and high prevalence of rheumatic and CHD. A 14-year-old boy with no prior heart disease presented with fever, cough, and chest pain. Echocardiography showed large aortic vegetation, severe regurgitation, and root abscess. Blood culture grew Streptococcus gallolyticus. Despite antibiotics, he required urgent COMMANDO surgery with aortic valve replacement and mitral valve replacement, underscoring fulminant pediatric IE. Initially postoperatively, the patient stabilized but subsequently developed refractory ventricular tachycardia and could not be revived. This case highlights the aggressive nature of pediatric IE, the potential for rapid progression, and the importance of early diagnosis, appropriate antimicrobial therapy, and timely appropriate surgical intervention. This case shows extensive involvement of multidisciplinary action for pediatric IE with extensive cardiac involvement. Successful management clues on early diagnosis, pathogen violence causing infection, disease growth progression, appropriate antibiotics, and timely surgical intervention.