Infective Endocarditis on Ventricular Septal Defect Complicated by Septic Pulmonary Emboli During Antibiotic Therapy: A Case Report and Literature Review

Background: Infective endocarditis (IE) remains a serious complication of congenital heart disease, particularly ventricular septal defect (VSD), which predisposes to endothelial injury and vegetation formation. Septic pulmonary embolism is a feared complication that may occur despite appropriate antimicrobial therapy. Case Presentation: We report the case of a 20-year-old woman with a known perimembranous VSD admitted for prolonged fever. Blood cultures isolated Streptococcus mitis, and transthoracic echocardiography revealed mobile vegetations on the right ventricular aspect of the septal defect. Despite favorable initial clinical and biological evolution under appropriate antibiotic therapy, she developed bilateral septic pulmonary emboli on day 14 of treatment. After completing six weeks of antibiotics, she underwent surgical closure of the VSD with good outcome and no residual vegetations. Conclusion: IE complicating VSD may present with atypical features and may evolve toward embolic complications even under adequate treatment. Echocardiography plays a central role in diagnosis, monitoring, and detection of complications. Early recognition of embolic events is essential to guide timely surgical management.