Introduction: Pulmonary valve infective endocarditis is a rare entity that may occur in children following corrective surgery for congenital heart disease and carries a significant risk of septic pulmonary embolism. Case: 10-year 7 months-old girl with Tetralogy of Fallot with pulmonary atresia, ventricular septal defect underwent left modified Blalock-Taussig shunt at 1 year 2 months of age followed by definitive repair with trans-annular patch, left pulmonary artery plasty and re-anastomosis at 9 years 9 months. Post repair she developed pulmonary valve infective endocarditis at 10 years 4 months, treated with intravenous antibiotics. Serial echocardiography demonstrated reduction in vegetationsize. This time she presented with 4-day history of fever and cough. On examination, BMI-11.36kgm-2. She was hemodynamically stable. She had a systolic murmur, RR-20/min, Spo2 -98%, reduced air entry on the right lower zone, mild splenomegaly on clinical examination. No peripheral stigmata of infective endocarditis. FBC had persistent leukocytosis, anemia, and thrombocytopenia. CRP-182 mg/L, ESR- 131 mm/hr, Blood cultures were negative. Echocardiography- tiny residual VSD, small OS ASD, mild MR, persistent pulmonary valve vegetation (6.4 × 4.7 mm), and a new small vegetation on the right ventricular side of the pulmonary valve. Contrast-enhanced CT chest demonstrated septic pulmonary emboli with evidence ofpulmonary valve vegetation, fusiform aneurysm of the right proximal descending pulmonary artery , emphysematous changes in right lower lobe. Despite intravenous antibiotics, multidisciplinary management, she deteriorated, and succumbed. Conclusions: Management requires intravenous antibiotics, echocardiographic monitoring, and multidisciplinary care, with surgical interventions indicated for persistent infection, hemodynamic compromise or recurrent septic pulmonary embolism.