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Background <p>Infective endocarditis presents unique challenges, particularly in individuals with congenital heart diseases, such as this case, where the patient had tetralogy of Fallot physiology secondary to double outlet right ventricle, and Fanconi anemia. This case describes how the combination of multiple factors necessitated multidisciplinary management.</p> Case presentation <p>A 45-year-old South Asian male patient with a known history of tetralogy of Fallot physiology secondary to double outlet right ventricle presented to our emergency department with fatigue, fever, and neurological deficits suggestive of an embolic stroke. Transthoracic echocardiography revealed severe pulmonary stenosis and a significant subaortic ventricular septal defect with vegetations, indicative of infective endocarditis.</p> <p>Magnetic resonance imaging of the brain demonstrated multiple infarcts, suggestive of an embolic event. Blood cultures grew <i>Streptococcus mitis</i>. The patient was admitted to the intensive care unit and treated with aggressive antibiotic therapy. However, his clinical course was complicated by disseminated intravascular coagulation and acute kidney injury, requiring hemodialysis and transfusion support. Despite interventions, his condition deteriorated further. Genetic consultation indicated Fanconi anemia, adding complexity to his clinical management.</p> Conclusion <p>This case is remarkable because the patient survived up into adulthood with double outlet right ventricle and tetralogy of Fallot physiology without prior corrective surgery, which is a rare occurrence. The embolic stroke, likely resulting from a septic embolus, and the presence of Fanconi anemia further complicated the clinical scenario. Despite aggressive treatment, the patient’s progression to refractory sepsis and disseminated intravascular coagulation ultimately resulted in cardiac arrest. This case underscores the importance of early recognition, multidisciplinary collaboration, and tailored therapeutic strategies in managing complex congenital heart diseases with infective endocarditis and other comorbidities.</p>

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Infective endocarditis in an adult male patient with tetralogy of Fallot physiology secondary to double outlet right ventricle presenting with stroke: a complex presentation with multiorgan dysfunction—a case report

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  • 发表日期：

    2026年3月10日

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  • Archisha Kalra,
  • Shaik Nafeez Javed,
  • Mounika Cherukuri,
  • Ganesh V. Shetty,
  • Chandrashekar Udyavara Kudru

摘要

Background

Infective endocarditis presents unique challenges, particularly in individuals with congenital heart diseases, such as this case, where the patient had tetralogy of Fallot physiology secondary to double outlet right ventricle, and Fanconi anemia. This case describes how the combination of multiple factors necessitated multidisciplinary management.

Case presentation

A 45-year-old South Asian male patient with a known history of tetralogy of Fallot physiology secondary to double outlet right ventricle presented to our emergency department with fatigue, fever, and neurological deficits suggestive of an embolic stroke. Transthoracic echocardiography revealed severe pulmonary stenosis and a significant subaortic ventricular septal defect with vegetations, indicative of infective endocarditis.

Magnetic resonance imaging of the brain demonstrated multiple infarcts, suggestive of an embolic event. Blood cultures grew Streptococcus mitis. The patient was admitted to the intensive care unit and treated with aggressive antibiotic therapy. However, his clinical course was complicated by disseminated intravascular coagulation and acute kidney injury, requiring hemodialysis and transfusion support. Despite interventions, his condition deteriorated further. Genetic consultation indicated Fanconi anemia, adding complexity to his clinical management.

Conclusion

This case is remarkable because the patient survived up into adulthood with double outlet right ventricle and tetralogy of Fallot physiology without prior corrective surgery, which is a rare occurrence. The embolic stroke, likely resulting from a septic embolus, and the presence of Fanconi anemia further complicated the clinical scenario. Despite aggressive treatment, the patient’s progression to refractory sepsis and disseminated intravascular coagulation ultimately resulted in cardiac arrest. This case underscores the importance of early recognition, multidisciplinary collaboration, and tailored therapeutic strategies in managing complex congenital heart diseases with infective endocarditis and other comorbidities.