Clinical case of complicated course of infectious endocarditis in a teenager

Abstract

Infective endocarditis (IE) is a heart disease of an infectious nature with a primary lesion of the endocardium, heart valves, ligaments, followed by dissemination of the process to various organs. Infective endocarditis still remains a disease that is difficult to diagnose and unpredictable in terms of outcomes; it is registered in all countries of the world. Despite all the advances in medicine, infective endocarditis remains an extremely dangerous disease, with a mortality rate of 10–30%. The most common causes of lethal outcome of IE are multiple complications: embolisms of various localization, including cerebral arteries, aneurysms, toxic lesions of the spleen, myocarditis and pericarditis, acute renal failure. Currently, in pediatric cardiology practice, the frequency of primary infective endocarditis, which occurs with a change in the clinical picture, its atypical variants, has increased. The awareness of doctors of all specialties about this problem, the correct and timely diagnosis of the disease allows prescribing adequate therapy earlier and thereby improves the prognosis. The aim of our work was to familiarize physicians with the clinical observation of a teenager with an atypical onset of primary infective endocarditis, occurring under the “mask” of acute cerebrovascular accident. Also, the peculiarity of this case was the primary diagnosis of hereditary thrombophilia in the patient and the possible debut of a demyelinating disease of the central nervous system during the examination, which certainly complicated the diagnostic search and affected the outcome of infective endocarditis. The significance of dental procedures preceding the disease in a child, unfortunately, was not properly appreciated by the parents, but it is the inflammatory process in the oral cavity that should be considered as a key etiological factor in the development of infective endocarditis in this case.