[Clinical analysis of infectious endocarditis in children with concomitant septic pulmonary embolism]

Objective: To analyze the clinical characteristics, diagnosis, and treatment of infectious endocarditis (IE) with septic pulmonary embolism (SPE) in children. Methods: A case series study was conducted. Clinical data of 10 children with IE complicated by SPE admitted to the Department of Cardiovascular Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 2023 to September 2025 were analyzed. The detection rates of three pathogen detection methods, including blood culture, metagenomic next-generation sequencing (mNGS), and vegetation culture, were compared. The clinical diagnosis, treatment, and follow-up outcomes were summarized. Results: Among the 10 children, there were 3 males and 7 females, with an age at presentation of 8.5 (6.6, 11.0) years. Congenital heart disease was present in 9 cases, and intracardiac implants were present in 4 cases. The main clinical manifestations included fever in 10 cases, cough in 4 cases, dyspnea in 4 cases, and chest pain in 3 cases. Six cases had dental caries. A total of 10 pathogens were detected in 9 children, including 2 fungi, 7 bacteria, and 1 Coxiella burnetii. Blood culture was positive in 7 cases, mNGS was positive in 8 cases, and vegetation culture was positive in 4 cases. Echocardiography revealed right-sided vegetations in all cases, and cardiac CT angiography showed multiple pulmonary lesions, including pulmonary artery filling defects, patchy opacities, and streaky shadows. Nine children underwent surgical treatment, and the duration of antimicrobial therapy was 3.0 (2.5, 8.0) months. Under multidisciplinary management, 4 cases were cured, 5 cases improved, and 1 case was under control at discharge. After 6 months of follow-up, pulmonary lesions resolved in 9 cases, and valvular regurgitation improved in 8 cases. Conclusions: Embolization of right-sided IE vegetations is an important cause of SPE in children. Adjunctive mNGS testing, when required, contributes to a higher pathogen detection yield in patients with IE.For right-sided IE, early surgical intervention is often required in addition to antimicrobial therapy.