ISOLATED RIGHT-SIDED PULMONARY VALVE INFECTIVE ENDOCARDITIS IN AN UNREPAIRED TETRALOGY OF FALLOT: A PAEDIATRIC CASE REPORT

Abstract

Isolated pulmonary valve infective endocarditis is an uncommon form of right-sided infective endocarditis, especially in children. It is rarely seen even among patients with congenital heart disease, making early diagnosis difficult because the presenting features often resemble severe respiratory infection or sepsis. We report the case of a 4-year-old girl with unrepaired tetralogy of Fallot who presented with persistent high-grade fever, cough, respiratory distress and thrombocytopenia. She was initially managed as sepsis with lower respiratory tract infection. Despite broad-spectrum antibiotics, fever persisted and inflammatory markers remained elevated. Repeated clinical assessment and echocardiography demonstrated vegetation over the pulmonary valve, confirming isolated right-sided pulmonary valve infective endocarditis. She received prolonged intravenous antibiotic therapy with gradual resolution of fever, improvement in inflammatory markers and recovery of platelet counts. This case highlights the importance of maintaining a high index of suspicion for infective endocarditis in children with cyanotic congenital heart disease who have persistent fever despite appropriate antimicrobial therapy. Early echocardiographic evaluation and timely treatment can improve clinical outcomes.