Adult patent ductus arteriosus complicated by pulmonary infective endocarditis

Abdelmjid El Adaoui, Rime Benmalek

PAMJ-CM. 2020; 3:161. Published 05 Aug 2020 | doi:10.11604/pamj-cm.2020.3.161.23956

We report the case of a 32 year-old male with Down Syndrome and a medical history of Immune thrombocytopenia (ITP) under corticosteroids, who was admitted to the cardiology department for prolonged fever and asthenia. On inspection, the conjunctivae were anemic and physical examination found a febrile patient (38.9°C) and a 3/6 continuous murmur in the pulmonary area. Blood tests revealed a normocystic, normochromic anemia (Hemoglobin 8.6 g/dL) and severe thrombocytopenia (9000/mm3), a leukocyte count of 12,500 cells/mm3, and high C-reactive protein and erythrocyte sedimentation rates. Thoracic X-ray showed cardiomegaly with normal lung area. Transthoracic Echocardiography (TEE) was immediately performed and showed a 7 mm Patent Ductus Arteriosus (PDA) associated to a large oscillating mobile vegetation attached to the pulmonic valve measuring 32 x 15 mm (A,B,C,D) with a dilated pulmonary artery and a severe pulmonary insufficiency. Right chambers were dilated (RV infundibulum= 37mm, RV basal diameter= 46 mm, RA surface= 24 cm2) with moderate tricuspid regurgitation and a transvalvular gradient of 68 mmHg, left valves were normal. Repeated blood cultures were sterile, empirical anbitiotherapy including Vancomycin and gentamycin was started with no significant improvement after 2 weeks. The patient underwent surgical vegectomy with pulmonic and tricuspid valves´ repair, and closure of PDA was not considered. Post-operative period was uneventful, after 2 additional weeks of antibiotherapy, the evolution was favorable with apyrexia, inflammation markors normalization and no residual vegetation in the post-operative TTE. The patient was discharged from hospital as he was asymptomatic and was advised regular follow up.
Corresponding author
Rime Benmalek, Resident in Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco (Rime.benmalek@gmail.com)
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