Severe cardiac infections are rare. We describe 2 cases of fulminant cardiac infections, presenting in term infants with features associated with primary immunodeficiency.

The first patient presented at age 15 days with poor feeding. Auscultation revealed soft heart sounds and 2D-echocardiogram showed a large pericardial effusion. The intracardiac structures were normal. The infant underwent open pericardiotomy. Cultures from the pericardial fluid were positive for Staphylococcus Aureus. The infant also had an ulcer over the left hip which was positive for Mycobacterium Bovis. He was strongly suspected to have Severe Combined Immunodeficiency. He died at 5 months of age with parainfluenzae pneumonitis.

The second patient presented at age 2 months with fever and an irritable left hip. Left hip ultrasound scan revealed an effusion and open drainage yielded pus, positive for Staphylococcus Aureus. 2D-echocardiography revealed right ventricular outflow tract vegetations. She underwent debridement of the vegetations. Tissue cultures were also positive for Mycobacterium Bovis. She was diagnosed with Severe Combined Immunodeficiency and underwent bone marrow transplantation at 6 months of age.

Risk factors for severe cardiac infections remain the presence of underlying congenital heart disease. The first patient had pericarditis in the presence of a structurally normal heart. As the second patient had presented acutely with endocarditis, one could not determine whether the valves had been structurally normal before the onset of endocarditis. These 2 infants, did not have any septal defects or patent arterial ducts. We propose that in infants with fulminant cardiac infections, one should look for associated immunodefiency.