Clinical Scenario:
A 12-year-old boy with a history of repaired tetralogy of Fallot presents with persistent fever for 10 days despite receiving intravenous ceftriaxone for presumed pneumonia. He remains febrile, and repeat blood cultures obtained before antibiotics remain sterile. Laboratory investigations show elevated CRP and ESR. Transthoracic echocardiography is inconclusive because of poor acoustic windows. Infective endocarditis is strongly suspected.
What is the most appropriate next step?
A. Add vancomycin
B. Repeat blood cultures
C. Transesophageal echocardiography
D. PET-CT scan
E. Stop antibiotics
Correct answer & Explanation:
Correct Answer: C. Transesophageal echocardiography
Explanation:
In patients with a high clinical suspicion of infective endocarditis and a non-diagnostic transthoracic echocardiogram, the next investigation is transesophageal echocardiography (TEE), which has much higher sensitivity for detecting vegetations, abscesses, and prosthetic valve involvement.
