Teenager with fever, petechiae, confusion, and weakness

Infective endocarditis is an uncommon but serious pediatric condition that requires a high degree of suspicion to diagnose.? Infectious endocarditis has been reported in patients withoutany risk factors and even in the presence of normal cardiacexamination findings. Most pediatric patients present withnonspecific signs and symptoms, which further highlights theimportance of a thorough physical examination in childrenpresenting with unexplained fever.? Blood culture and echocardiography are the most importantinitial diagnostic tests. Empirical treatment includes vancomycinand gentamicin (with rifampin for patients with prostheticvalves) until culture and sensitivity results are available.