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2022, Number 2

Cardiovasc Metab Sci 2022; 33 (2)

Difficult diagnosis infective endocarditis in a pediatric patient: case report

Ferro, Daniela; Urrutia, Julian; Cortés, María Camila; Rodríguez, Sebastián; Jaramillo, Andrés

ABSTRACT

Infective endocarditis (IE) remains a diagnostic challenge because its clinical manifestations are nonspecific and mimic other entities. IE has been extensively studied and documented in adults but less so in children. Here we describe a clinical case of IE that is difficult to diagnose. This is a thirteen-year-old male patient who came to the emergency department of the Hospital Infantil Universitario de San José due to fever for one year, predominantly in the afternoon. The patient has a history of corrected myelomeningocele, Arnold Chiari malformation type 1, neurogenic bladder and hydrocephalus and is a user of the ventriculoatrial shunt. On admission, a urinary tract infection by a multidrug-resistant germ was documented, which was initially considered the cause of his fever. Multiple echocardiograms were performed, all without evidence of IE. However, in addition to fever and ventriculoatrial shunt, Streptococcus mitis bacteremia and positive rheumatoid factor were documented, establishing a definitive diagnosis of IE according to modified Duke criteria. This case illustrates the importance of maintaining a high suspicion of IE, even in patients with an atypical clinical presentation without specific findings for IE and directing additional studies based on the Duke criteria. This requires knowledge of the typical etiologic microorganisms as well as the findings that constitute the vascular and immunologic phenomena contemplated in the modified Duke criteria.
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Keywords

Infective endocarditis pediatric assistant endocarditis cardiology echocardiogram




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Cardiovascular and Metabolic Science Vol. 33, Num. 2, Abril-Junio 2022. Es una publicación trimestral editada por la Asociación Nacional de Cardiólogos de México. Magdalena 135. Col. Del Valle. Del. Benito Juárez. Ciudad de México, México. C.P. 03103. Tel. 5556368002 https://www.cardiovascularandmetabolicscience.org.mx/ ancam@ancam.org.mx Editor responsable. Dr. Eduardo Meaney Mendiolea. Reserva de Derechos al Uso Exclusivo Nº 04-2019-061316491900-203. ISSN: EN TRÁMITE. Ambos otorgados por el Instituto Nacional del Derecho de Autor. Responsable de la última actualización de este número, Departamento de Internet, Graphimedic, S.A. de C.V., Ing. Luis Rosales Jiménez, Coquimbo 936, Col. Lindavista, Delegación Gustavo A. Madero, C.P. 07300, Ciudad de México, México. Fecha de última modificación, 1 de julio de 2022.

 

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