Anna Mikami, Michael Sherwood, Abrag Nassar, Jennifer Burnham, Miriam Benavides, Samhrutha Sripathi, Chezhiyan Murugesan
Kern Medical Center.
United States
Cureus
Cureus 2025; 17:
DOI: 10.7759/cureus.94673
Abstract
We present a case of a six-year-old female patient with a history of rheumatic heart disease (RHD), including mitral stenosis, mitral regurgitation, and pulmonary hypertension, who presented with fever, abdominal pain, and urinary findings. Although urinalysis and imaging confirmed bilateral pyelonephritis, the admitting provider noted concerning physical exam findings, including Janeway lesions and systemic features that raised suspicion for concurrent infective endocarditis (IE). In the context of her underlying valvular disease, these exam clues broadened the differential beyond a presumed urinary source and prompted an endocarditis-focused evaluation. This case underscores the enduring value of a careful physical examination, the need to maintain a wide diagnostic lens, and the importance of tailoring sepsis management for pediatric patients with complex cardiac comorbidities.
Category
Class II. Pulmonary Hypertension Associated with Valvular Disease of the Left Side of the Heart
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes