Bacterial endocarditis of a ventricular septal defect in a 21 month old child.

The authors report a case of streptococcus mitis endocarditis of a ventricu lar septal defect in a 21 months old girl admitted for necrotic purpura of the lower limbs and a history of general ill health and pyrexia for two mon ths. The severity of this case of endocarditis was illustrated by the importance of the vasculitis, the biological signs of infection (disseminated intrava scular coagulation), and the size of the vegetation. The vegetation extende d from the tricuspid valve as far as the pulmonary orifice which was partia lly obstructed, causing signs of right ventricular failure. The portal of e ntry was not found. Surgical ablation of the vegetation with tricuspid valv uloplasty was necessary after 48 hours of antibiotherapy. The outcome after one year's follow-up is good. The diagnosis of bacterial endocarditis must be considered even in very you ng children, especially those with congenital heart disease, and, in partic ular, ventricular septal defect.