Surgical treatment of infective endocarditis with massive vegetations in a patient with a ventricular septal defect and atopic dermatitis: a case report

Background It is well known that congenital heart disease, especially a ventricular septal defect, is associated with a high risk of infective endocarditis. There are few reports of infective endocarditis with vegetations extending from the right ventricle into the pulmonary artery, resulting in pulmonary artery embolism. It is also well known that atopic dermatitis can be associated with systemic infections such as infective carditis. Here, we report a patient with a ventricular septal defect and infective endocarditis caused by atopic dermatitis who presented with massively infected vegetations occluding the pulmonary artery and extending from the right ventricle into the pulmonary artery and was treated surgically. Case presentation A 26-year-old woman with a ventricular septal defect and a history of atopic dermatitis was diagnosed with infective endocarditis with mobile vegetations in the right ventricle, pulmonary artery occlusion caused by massive vegetations, and pulmonary abscesses. Because the obstructing vegetations did not regress with antibiotics, they were removed surgically and the ventricular septal defect was closed. A new causative organism was identified in the vegetation, enabling optimization of the antibiotic regimen. Appropriate antibiotics were administered for 2 months after surgery, resulting in complete resolution of the lung abscesses. Conclusion Aggressive surgical intervention can be effective in patients with massive vegetations obstructing their pulmonary arteries.