Philippine E-Journals

Pulmonary Endarteritis in a 24-year-old Male with Patent Ductus Arteriosus

Ervin L. Santos

 

Abstract:

Introduction: The ductus arteriosus, an essential fetal structure, normally closes spontaneously soon after birth. It’s persistence into late adulthood is considered rare. infective endarteritis complicating a patent ductus arteriosus (PDA) is an even rarer event. The clinical picture of an infected PDA could be subtle, and the diagnosis is frequently delayed. Symptoms may well be attributed to community acquired pneumonia, pleurisy, or pulmonary infarction from pulmonary embolism. In cases of a silent PDA, extensive work-up of fever of unknown origin is needed to arrive at the correct diagnosis. Case: This is a case of a 24-year-old male known to have Patent Ductus Arteriosus who came in due to on and fever for months. Patient denied any associated signs and symptoms aside from headache. Several consults were done and fever was attributed to a urinary tract infection. On cardiac examination, a machinery-like murmur at the second intercostal space left parasternal border was noted. Other aspects of the physical examination were unremarkable. Two-dimensional echocardiogram revealed a 0.9x1.0cm echo dense structure on the left pulmonary artery and was diagnosed as Infective Endarteritis. Blood culture were positive for Streptococcus Viridans. Penicillin IV was started and continued for four weeks with improvement. Repeat two-dimensional echocardiogram showed disappearance of the echodense structure. Patient was advised to have surgical correction of patent ductus arteriosus. Discussion/Conclusion: The clinical endarteritis syndrome is highly variable. Careful clinical, microbiologic, and echocardiographic evaluation should be pursued to avoid delayed or missed diagnosis.