Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 11016-11023
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.11016
Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant: A case report
Yan-Feng Yang, Fei-Fei Si, Ting-Ting Chen, Ling-Xia Fan, Ya-Heng Lu, Mei Jin
Yan-Feng Yang, Fei-Fei Si, Ting-Ting Chen, Ling-Xia Fan, Ya-Heng Lu, Mei Jin, Department of Pediatric Cardiology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
Author contributions: Yang YF and Si FF designed the research; Jin M, Fan LX, Lu YH, and Chen TT performed the echocardiography; Yang YF and Si FF wrote and edited the paper; all authors approved the final version of this manuscript.
Informed consent statement: This case study was approved by the ethics committee of the Chengdu Women and Children’s Hospital, Sichuan, China. Written informed consent for publication of clinical details and images was obtained from the patient’s parents.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Feng Yang, MD, Doctor, Department of Pediatric Cardiology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617 Riyue Ave, Qingyang district, Chengdu 610000, Sichuan Province, China. ymm810301@163.com
Received: May 17, 2021
Peer-review started: May 17, 2021
First decision: June 15, 2021
Revised: June 25, 2021
Accepted: October 25, 2021
Article in press: October 25, 2021
Published online: December 16, 2021
Processing time: 206 Days and 16.9 Hours
Abstract
BACKGROUND

Surgical therapy of infective endocarditis (IE) involving aortic valves and mitral valves is widespread. However, there are few reports concerning patients with culture-negative endocarditis complicated by the appearance of comorbid valvular perforation and abscess. Therefore, real-time surveillance of changes in cardiac structure and function is critical for timely surgical management, especially in patients who do not respond to medical therapy.

CASE SUMMARY

Here, we report an atypical case in a 9-mo-old infant without congenital heart disease but with symptoms of intermittent fever and macular rashes. Physical examination, laboratory tests, and electrocardiograms suggested a diagnosis of IE, although the result of blood cultures was exactly negative. After treatment with antibiotic drugs, the patient got a transient recovery. On the 9th day, we proceeded with continuous echocardiogram due to fever again and the results revealed aortic valve abscess with perforation, regurgitation, vegetation, and pericardial effusion. Intraoperative monitoring revealed aortic valve perforation, presence of apothegmatic cystic spaces below the left coronary cusp of the aortic valve, and severe aortic valve regurgitation. Aortic valve repair was performed by autologous pericardial patch plasty. The patient was discharged after 4 wk of treatment and no complications occurred after surgery.

CONCLUSION

Our case demonstrated the necessity of serial echocardiography monitoring for possible adverse symptoms of IE in pediatric patients.

Keywords: Infective endocarditis; Aortic regurgitation; Abscess; Blood culture-negative; Echocardiography; Case report

Core Tip: We report an atypical case in a 9-mo-old infant without congenital heart disease. Laboratory tests and electrocardiograms suggested a diagnosis of infective endocarditis (IE). After being treated with antibiotic drugs, the patient got a short recovery. Continuous echocardiographic examinations since admission revealed aortic valve abscess with perforation, regurgitation, vegetation, and effusion. Aortic valve repair was performed by using autologous pericardial patch plasty. No postoperative complications occurred and the patient was healthily discharged after 4 wk of treatment. Our case demonstrated the necessity of serial echocardiography monitoring in pediatric patients for possible adverse symptoms of IE.