Huge, Invasive, and Destructive Abiotrophia Defectiva Endocarditis of the Aortic Valve and the Aortic Wall. A Case Report of an Emergency but Successful Ross-Konno Operation in a Child

Abiotrophia defectiva forms Gram-positive cocci, part of normal oropharyngeal and gastrointestinal flora and is rarely involved in endocarditis in children population. Its special nutritional requirements and subacute clinical course, may delay diagnosis and proper treatment, leading to life-threatening consequences. We report a rare case of huge and destructive Abiotrophia Defectiva infective endocarditis of the aortic valve and the aortic wall in a 3-years-old child, in follow-up after surgical valvuloplasty for congenital aortic stenosis. The child presented at our department with signs of left side hemiplegia. Transthoracic echocardiography showed severe aortic regurgitation due to large vegetation extending to the aortic wall up to the aortic arch. Blood cultures resulted positive for A. Defectiva. Initially treated conservatively with antibiotic therapy, but 10 days after admission, sudden clinical deterioration, required intubation and an emergency Ross-Konno operation. Despite the critical conditions and highly risky surgery, the child recovered well and was discharged home 5 weeks after the operation. A. Defectiva IE is rare in children. Since 1995, only sixteen cases of A. Defectiva IE have been reported in children, including our case. This pathogen has a higher rate of complications when affecting children rather than adult population. Our case demonstrates that conservative strategy with antibiotics is rarely resolutive in case of IE caused by A. Defectiva. Whenever one or more indications for surgery are present, surgical intervention should be always taken into consideration, even if clinical conditions are prohibitive and surgery is at very high risk.