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
ABSTRACTInfective 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.