ACUTE LIMB ISCHEMIA AS FATAL AND RARE COMPLICATION IN PEDIATRIC INFECTIVE ENDOCARDITIS CASE
Irma Arniawati,Sri Rahayuningsih,Rahmat Kuswiyanto
Universitas Padjadjaran Hasan Sadikin Hospital
Background : Incidence of infective endocarditis (IE) in children is rare, but has high rate of morbidity and mortality. Almost all cases of IE are preceded by heart defect either congenital or acquired. Infective endocarditis can be diagnosed with Modified Duke Criteria. One of fatal complication of IE is systemic thromboembolism such as acute limb ischemic. Early detection and intervention must be performed to prevent fatal complication.
Case Presentation Summary : A 12-year-old girl came with chief complain of shortness of breath and fever. Patient was diagnosed with Patent Ductus Arteriosus (PDA). On physical examination showed signs of heart failure, severe malnutrition, and reversible pulpitis. Laboratory investigations showed sign of infections without growth of microorganisms. Echocardiography showed moderate PDA, with multiple vegetation in the main pulmonary artery and left atrium. Patient was given heart failure drugs and intravenous ceftriaxone and gentamicin as antibiotic choice for IE. She diagnosed as acute limb ischemia at cruris sinistra and performed emergency transtibial amputation below knee. During operation, there was thrombus in the posterior and anterior tibial arteries. On echocardiography evaluation, vegetation was not found. Patient then performed transcateterization closure of PDA with device. On post-closure PDA echocardiography there was no shunt residual. Patient discharged from hospital with good condition.
Learning Points/Discussion : Infective endocarditis is a rare case that potentially threaten life or cause disability. A 12 year old girl diagnosed with infective endocarditis and PDA. During hospitalization, there was acute limb ischemic as rare and fatal complication. Definitive treatment of infective endocarditis is closure of heart defect which in this case is PDA.