‘Scarcity amidst plenty’- A rare combination of enterococcal pulmonary valve endocarditis in a young girl: A case report

Isolated pulmonary valve infective endocarditis (IE) with Enterococcus faecalis in a child with an underlying ventricular septal defect (VSD) is rare. A ten year old girl with a VSD with moderate to severe right ventricular mid cavity obstruction presented with fever and loose stools. Examination did not reveal any peripheral stigmata of IE. Five of six blood cultures sent in two sets 12 hours apart, grew E. faecalis sensitive to β-lactams. 2D echocardiography revealed a 7×4 mm vegetation on the pulmonary valve. She was treated with intravenous antibiotics for 6 weeks. Inflammatory markers normalized by 6 weeks and the vegetation cleared by the 7^th week. Amongst the aetiological agents, isolation of Enterococcus faecalis is rare in children and drug resistance is an emerging problem. Enterococcus species related native valve IE needs a prolonged course of therapy with penicillin G/ampicillin together with gentamicin for 4-6 weeks. Heart failure and cerebral embolization are the most commonly encountered complications.