Native-valve Infective Endocarditis Complicated by a Left Foot Gangrene in a Nigerian Girl

Abstract

Background: Infective endocarditis (IE) involving native valves in children without underlying structural or acquired valvular heart disease is uncommon. Most reported paediatric cases occur in the presence of congenital cardiac defects or pre-existing valvular abnormalities that serve as a nidus for infection. IE is associated with significant morbidity and mortality, particularly when complicated by congestive cardiac failure or systemic embolization. Reports of systemic embolic phenomena complicating IE in African children are scarce, and peripheral gangrene as a presenting feature is especially rare. Aim: To highlight an unusual presentation of paediatric native-valve infective endocarditis complicated by systemic embolization resulting in limb gangrene, and to emphasize the need for a high index of suspicion in atypical presentations. Case Presentation: We report the case of a 7-year-old girl with no known structural heart disease who presented with left foot gangrene secondary to systemic embolization. Further evaluation revealed native-valve infective endocarditis as the underlying cause. The diagnosis was established through clinical findings, echocardiographic evidence of valvular vegetation, and supportive laboratory investigations. The patient was managed with appropriate antimicrobial therapy and multidisciplinary care for the embolic complication was planned. Discussion: Pediatric IE is rare, particularly in children without identifiable cardiac risk factors. Its clinical presentation can be highly variable and occasionally misleading, especially when embolic phenomena precede or overshadow classical cardiac features. Systemic embolization is a recognized complication of IE, but progression to peripheral gangrene is distinctly uncommon. This case underscores the diagnostic challenge posed by atypical presentations and highlights the importance of early echocardiographic assessment and prompt treatment. The report also contributes to the limited African literature on embolic complications of IE in children. Conclusion: This case illustrates a rare and severe complication of native-valve infective endocarditis in a child without pre-existing heart disease. Awareness of such atypical presentations is crucial for early diagnosis and timely management to prevent adverse outcomes.