When Time Is of the Essence: Multifocal Infective Endocarditis in a Young Patient

Infective endocarditis (IE) is uncommon in adolescents but may cause severe morbidity, especially with congenital heart disease (CHD) or delayed diagnosis. A 17-year-old male with a presumed closed perimembranous ventricular septal defect (VSD) presented with five months of weight loss, malaise, fevers, cough and pleuritic chest pain. A new pansystolic murmur prompted transthoracic echocardiography (TTE), which was highly suggestive of mitral and pulmonary valve vegetations with evidence of severe valvular regurgitation. Blood cultures grew Streptococcus mitis and computed tomography (CT) demonstrated pulmonary septic emboli. Progressive multivalvular destruction required transfer to a tertiary adult CHD and cardiothoracic centre where he underwent complex cardiac surgery. He underwent mitral and tricuspid valve repair, pulmonary valve replacement, VSD closure and resection of a double-chambered right ventricle (DCRV). Postoperative complete atrioventricular (AV) block required temporary epicardial pacing, but intrinsic rhythm remained stable and AV conduction subsequently recovered. This case highlights the impact of diagnostic delay in adolescent IE and the importance of early identification, multidisciplinary team (MDT) management and prompt intervention in this patient cohort.