Delayed Diagnosis of Right-Sided Infective Endocarditis with Septic Pulmonary Emboli in a Dextrocardia Patient During the COVID-19 Pandemic

An adolescent IDU presented with persistent fever and cough. Echocardiography revealed dextrocardia, severe tricuspid regurgitation, and vegetation on the tricuspid leaflet. CT pulmonary angiography identified multiple pulmonary infarcts, and blood cultures confirmed Staphylococcus aureus infection. The patient was diagnosed with right-sided infective endocarditis (IE) complicated by septic pulmonary emboli. She was treated with antibiotics followed by cardiac surgery. While the role of dextrocardia in IE is not well established, it significantly affects the surgical management approach. The diagnosis of right-sided IE and septic pulmonary embolism was delayed during the COVID-19 pandemic due to overlapping symptoms with respiratory infections. Early recognition and prompt investigation in high-risk patients are crucial to address this diagnostic challenge.