# A Rare Case of Pediatric Infective Endocarditis Initially Presenting as Meningitis in a Previously Healthy Child

## TL;DR

A previously healthy child was misdiagnosed with meningitis but later found to have infective endocarditis, requiring surgery and antibiotics for recovery.

## Contribution

Highlights the diagnostic challenges of pediatric IE without cardiac risk factors and the importance of early surgical intervention.

## Key findings

- The child developed septic embolic events despite antibiotic therapy for initially diagnosed meningitis.
- Echocardiograms revealed mitral valve vegetation and aortic root abscess caused by MSSA.
- Successful surgical management and IV antibiotics led to full recovery.

## Abstract

Infective endocarditis (IE) is a rare but life-threatening condition in children, particularly in those without heart disease. Delayed diagnosis can lead to serious systemic complications. We report the case of an eight-year-old previously healthy girl, initially misdiagnosed with bacterial meningitis, who developed multiple septic embolic events (cerebral infarcts, digital gangrene, and splenic and renal infarction) despite being on antibiotic therapy. Repeat echocardiograms revealed mitral valve vegetation and an aortic root abscess. Blood cultures (aerobic and anaerobic) grew methicillin-sensitive Staphylococcus aureus (MSSA). She underwent successful surgical management via a modified Ross procedure, followed by a six-week course of intravenous (IV) flucloxacillin, resulting in full recovery. This case underscores the diagnostic challenges of pediatric IE in patients without known cardiac risk factors and highlights the critical role of serial imaging, multidisciplinary care, and early surgical intervention in achieving favorable outcomes.