Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant: A case report

Abstract

BACKGROUND Surgical therapy of infective endocarditis (IE) involving aortic valves and mitral valves is widespread. However, there are few reports concerning patients withculture-negative endocarditis complicated by the appearance of comorbidvalvular perforation and abscess. Therefore, real-time surveillance of changes incardiac structure and function is critical for timely surgical management,especially in patients who do not respond to medical therapy.CASE SUMMARYHere, we report an atypical case in a 9-mo-old infant without congenital heartdisease but with symptoms of intermittent fever and macular rashes. Physicalexamination, laboratory tests, and electrocardiograms suggested a diagnosis of IE,although the result of blood cultures was exactly negative. After treatment withantibiotic drugs, the patient got a transient recovery. On the 9th day, we proceededwith continuous echocardiogram due to fever again and the results revealedaortic valve abscess with perforation, regurgitation, vegetation, and pericardialeffusion. Intraoperative monitoring revealed aortic valve perforation, presence ofapothegmatic cystic spaces below the left coronary cusp of the aortic valve, andsevere aortic valve regurgitation. Aortic valve repair was performed byautologous pericardial patch plasty. The patient was discharged after 4 wk oftreatment and no complications occurred after surgery.CONCLUSIONOur case demonstrated the necessity of serial echocardiography monitoring forpossible adverse symptoms of IE in pediatric patients