Late Achromobacter endocarditis after device closure of ventricular septal defect: a case report

Among all congenital heart diseases, ventricular septal defect (VSD) is the most common. Transcatheter device closure of VSD is an increasingly practiced intervention in recent times because patients can avoid the burden of surgery and associated morbidity. Infective endocarditis (IE) associated with this intervention is a very rare occurrence. Patients are considered to be at high risk of developing IE in the initial 6 months after septal defect closure device implantation.

We report a case of late IE in a 7 years old female. She had a transcatheter device closure of a perimembranous VSD at the age of 3, using a Konar MFO device. The patient presented with altered consciousness, convulsions, moderate fever and tachycardia. MRI of brain revealed basilar and posterior inferior cerebellar artery thrombosis leading to central pontine and right cerebellar infarct. Transoesophageal echocardiography displayed mobile thread like vegetation attached to the left knob of the MFO device just below the aortic valve. Blood culture revealed Achromobacter xylosoxidans growth. A diagnosis of IE was reached.

Transcatheter device closure of VSD has been shown to be safe and effective in various studies. IE associated with this intervention is extremely rare with just a handful of cases reported. As far as we are aware, this is the first reported case of IE associated with VSD device due to A. xylosoxidans.