Pulmonary endarteritis in a patient with patent ductus arteriosus and a bicuspid aortic valve.

BACKGROUND: Infective endarteritis of the pulmonary artery is an unusual event. While congenital heart disease (CHD) is a risk factor, pulmonary endarteritis as a complication is a rare occurrence especially in the era of antibiotic therapy.
CASE PRESENTATION: We present a case of a 43-year-old female who initially sought consultation due to fever. Physical examination revealed a continuous murmur at the second intercostal space left parasternal border. There was no petechiae or any other skin lesions noted. Transthoracic two dimensional echocardiogram showed eccentric left ventricular hypertrophy with an ejection fraction of 65%. She had a patent ductus arterioscus as well as a bicuspid aortic valve. Further interrogation revealed a vegetation at the main pulmonary artery. Patient was initially started on ceftriaxone and gentamycin. Blood cultures were positive for coagulase negative Staphylococcus aureus. Ceftriaxone was then shifted to vancomycin, which was completed for 28 days.
OUTCOME: Clinical improvement was accompanied by the disappearance of the vegetation and negative blood cultures. Patient was maintained on enalapril and advised closure of the patent ductus arteriosus. She opted medical management for the time being and was discharge stable and improved.
CONCLUSION: Pulmonary endarteritis is an uncommon complication of CHD. A high index of suspicion must prompt careful evaluation, combining clinical, laboratory and echocardiographic modalitites in order to provide early diagnosis and effective treatment.