INFECTIVE ENDOCARDITIS MIMICKING AS PAPILLARY FIBRO ELASTOMA - A RARE PRESENTATION IN AN ADULT WITH VSD

A diagnosis of congenital heart disease is usually established at an early age, so infective endocarditis is a rare form of presentation. We here describe the case of a 35 year male with a week-long history of intermittent fever, pleuritic chest pain and breathlessness. Physical examination detected pan systolic murmur and an associated precordial thrill. ECHO revealed a perimembranous ventricular septal defect, pedunculated masses involving Right Ventricular Outflow Tract (RVOT) and Main Pulmonary Artery (MPA) with free valvular surface. CT Chest showed bilateral wedge shaped consolidatory changes suggestive of pulmonary infarcts secondary to embolism from cardiac masses. Cardiac MRI taken to r/o benign cardiac tumors which can present as pedunculated masses with embolism. Also laboratory tests showed evidence of an active infection. With this, the diagnosis of infective endocarditis involving RVOT and MPA (with free valvular surface ) with septic pulmonary thrombo embolism was made. He was not willing for massectomy and so he was started on intravenous antibiotics,anticoagulantss and anticongestive therapy. The outcome has been generally favorable, and at present he is asymptomatic under anticongestive therapy.