Infective endocarditis due to Granulicatella adiacens in a child with congenital heart disease. Case Report

Nery-Zavaleta C.Y.; Nario-Lazo V.; Genaro-Saldaña S.V. · Acta Pediatrica de Mexico (2022) · DOI: 10.18233/apm43no3pp174-1782295

Resumen

INTRODUCTION: Infective endocarditis (IE) due to Granulicatella adiacens is a rare disease in children, but with significant morbidity and mortality. Children with congenital heart disease (C H D) are at increased risk of developing IE, and Granulicatella species endocarditis can be difficult to treat. PRESENT THE CASE: Seven-year-old male patient with a history of pulmonary atresia, patent ductus arteriosus (PDA), uncorrected ventricular septal defect (VSD) and multiple aortopulmonary collaterals (MAPCAS), who presented signs and symptoms of IE, with vegetations on echocardiogram and a positive blood culture for Granulicatella adiacens. He received ceftriaxone plus vancomycin for six weeks and gentamicin for the first two weeks. The patient developed immune-mediated glomerulonephritis and acute renal failure. A clinical and laboratory improvement was achieved; and no vegetation was found at discharge. CONCLUSIONS: IE due to Granulicatella is an entity that should be considered in the pediatric population with C H D, especially of the cyanotic type. Treatment with ß-lactams plus aminoglycosides is usually first-line empirical therapy. Vancomycin may also be an alternative drug option in resistant strains. We suggest an approximate follow-up of kidney involvement that can develop as a complication of IE itself, as well as due to drug nephrotoxicity.

Instituciones: Universidad Peruana Cayetano Heredia; Universidad Nacional Mayor de San Marcos