Pulmonary Infectious Endarteritis Associated With Patent Ductus Arteriosus.

https://e-jcvi.org A 52-year-old man presented with fever of unknown origin for 3 months. The fever persisted even after taking antibiotics. One month before he developed the fever, he underwent acupuncture and phlebotomy several times. The patient had a cardiac symptom of shortness of breath during exercise, with a continuous murmur at the pulmonic position on physical examination. Transthoracic echocardiography (TTE) revealed a dilated pulmonary artery (PA) and a left to right shunt between the descending thoracic aorta and PA (peak velocity 4.5 m/s, Figure 1A and B), suggesting the presence of a patent ductus arteriosus (PDA). Chest computed tomography (CT) revealed multiple consolidations in both lungs, suspicious of embolic pneumonia (Figure 1C). Streptococcus sanguinis was isolated from 2 sets of blood cultures. The patient underwent transesophageal echocardiography (TEE), which revealed hypermobile linear materials in the PA (Figure 1D-F). On heart CT, a PDA at the end of the aorta (8.5 mm in size), calcification of the ostium, and abutting aorta were detected (Figure 1G). On 2-dimensional (2D) and 3D CT, images clearly showed an ill-defined nodular lesion (0.6 cm) attached to the medial side of the main PA (Figure 1H and I). The patient was diagnosed with a PDA accompanied by infectious endarteritis and septic embolic pneumonia. A combination of gentamicin (3 mg/kg daily) and intravenous ceftriaxone (2 g daily) was initiated. Despite 2 weeks of antibiotics, the fever recurred, and follow-up TEE showed remaining vegetation in the main PA. Therefore, surgical removal of the vegetation and PDA obliteration were performed. Post-operative TTE revealed no residual PDA flow, and the patient remained afebrile with a negative blood culture. He was discharged and followed up at an outpatient clinic without any subsequent evidence of infection.