scholarly journals The advantages and limitations of echocardiography in a unique presentation of double-sided endocarditis from intravenous drug use

2016 ◽  
Vol 3 (3) ◽  
pp. 26
Author(s):  
Ben Alencherry ◽  
Claire Sullivan ◽  
Brian Hoit
Keyword(s):  
Infective Endocarditis ◽  
Intravenous Drug User ◽  
Posterior Wall ◽  
Intravenous Drug ◽  
Valvular Regurgitation ◽  
Intravenous Drug Use ◽  
Multiple Organs ◽  
Posterior Mitral Leaflet ◽  
History Of ◽  
Extent Of Disease

A 25-year-old female intravenous drug user presented with a three-week-history of fever and myalgias and was found to have infective endocarditis affecting the mitral and tricuspid valves.  Blood cultures grew methicillin sensitive Staphylococcus aureus. Computed tomography showed emboli in multiple organs.  Transthoracic echocardiogram revealed large vegetations on the mitral valve with moderate valvular regurgitation and a transesophageal echocardiogram identified a posterior mitral leaflet perforation.  The patient underwent urgent surgical intervention after developing respiratory distress from worsening congestive heart failure.  Intraoperative findings in addition to those found on echocardiography included a large abscess in the posterior wall of the left atrium.  The patient underwent mitral and tricuspid valve replacement due to valve damage.  This case shows a unique presentation of valvular involvement of infective endocarditis and the capabilities and limitations of echocardiography in assessing the extent of disease in this condition.

Ocular Toxocariasis Presenting as Endophthalmitis in a Young Adult Intravenous Drug User

2020 ◽  
pp. 247412642094658
Author(s):  
Pali P. Singh ◽  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Durga S. Borkar ◽  
Sharon Fekrat
Keyword(s):  
Drug User ◽  
Intravenous Drug User ◽  
Toxocara Canis ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Ocular Toxocariasis ◽  
Fundus Imaging ◽  
Common Causes ◽  
History Of ◽  
Optical Coherence Tomography Imaging

Purpose: This report describes the diagnosis of ocular toxocariasis presenting as endophthalmitis in an adult intravenous drug user. Methods: A case is reported. Results: Fundus imaging showed numerous white opacities obscuring the macula. Toxocara canis serology was reactive with an enzyme immunoassay titer of 1:2 (positive ≥ 1:32). Findings from bacterial and fungal cultures were negative, and vitrectomy cytology revealed no organisms. Postoperatively, serial optical coherence tomography imaging demonstrated a slight decrease in size of an intraretinal hyperreflective lesion in the macula. Conclusions: Owing to a variety of presentations, ocular toxocariasis can be challenging to diagnose. In a patient with a history of intravenous drug use where fungal and bacterial organisms are more common causes of endophthalmitis, it is important to have a wide differential of causative organisms, particularly in the context of negative culture results and a worsening clinical examination.

scholarly journals Septic Pulmonary Embolism Causing Recurrent Pneumothorax in an Intravenous Drug User without Right-Sided Valvular Vegetation in Infective Endocarditis

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Mason Montano ◽  
Kevin Lee ◽  
Kushal Patel ◽  
Mutsumi Kioka
Keyword(s):  
Pulmonary Embolism ◽  
Infective Endocarditis ◽  
Pulmonary Valve ◽  
Rare Complication ◽  
Intravenous Drug User ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Indwelling Catheters ◽  
Septic Pulmonary Embolism ◽  
Valve Lesions

The following report illustrates a case of a 36-year-old Caucasian male with intravenous drug use (IVDU) induced septic thrombophlebitis presenting with recurrent unilateral pneumothoraces from septic pulmonary embolism (SPE) without the presence of obvious right-sided valvular vegetation in infective endocarditis (IE), defined as tricuspid or pulmonary valve lesions. Pneumothorax (PTX) has been observed as a rare complication of SPE and is commonly associated with infective right-sided IE, IVDU, and intravascular indwelling catheters. However, this case is novel as it is the very rare documented case of recurrent, unilateral, spontaneous right PTX refractory to multiple chest tube placements in such a setting. Therefore, the absence of detectable right-sided valvular vegetation in IE does not obviate the risk of SPE-induced PTX in IVDU and further expands the realm of infectious and pulmonary consequences of SPE and IVDU.

The Lived Experience of Nurses Caring for Patients Diagnosed With Intravenous Drug Use–Associated Infective Endocarditis in Appalachia: A Phenomenological Study

2021 ◽  
pp. 107839032110377
Author(s):  
Kendrea L. Todt ◽  
Sandra P. Thomas
Keyword(s):  
Substance Use ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Substance Use Disorder ◽  
Phenomenological Study ◽  
Care Delivery ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Central Theme ◽  
Number Of Patients

BACKGROUND: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. OBJECTIVE: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. METHOD: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. RESULTS: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. CONCLUSIONS: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses.

A Man with a History of Intravenous Drug Use and Diffuse Small Nodular Lung Opacities on Imaging

2021 ◽  
Vol 18 (12) ◽  
pp. 2079-2083
Author(s):  
Bryton E. Perman ◽  
Ian Jackson ◽  
Ali Nayfeh ◽  
Shraddha Narechania
Keyword(s):  
Drug Use ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
History Of

Drug use-related right-sided infective endocarditis complicated by empyema and bronchopleural fistula

2022 ◽  
Vol 15 (1) ◽  
pp. e246663
Author(s):  
Lindsey M Shain ◽  
Taha Ahmed ◽  
Michele L Bodine ◽  
Jennifer G Bauman
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Bronchopleural Fistula ◽  
Disease Process ◽  
Intravenous Drug ◽  
Pulmonary Emboli ◽  
Intravenous Drug Use ◽  
Respiratory Complications

Right-sided infective endocarditis is frequently accompanied by septic pulmonary emboli, which may result in a spectrum of respiratory complications. We present the case of a 25-year-old woman diagnosed with infective endocarditis secondary to intravenous drug use. During a long and arduous hospital course, the patient developed empyema with bronchopleural fistula, representing severe but uncommon sequelae that may arise from this disease process. She was treated with several weeks of antibiotics as well as surgical thorascopic decortication and parietal pleurectomy.

scholarly journals Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Heerani Woodun ◽  
Sarah Bouayyad ◽  
Sura Sahib ◽  
Nadir Elamin ◽  
Steven Hunter ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Intravenous Drug User ◽  
Blood Cultures ◽  
Topical Steroids ◽  
Foramen Ovale ◽  
History Of ◽  
The Right ◽  
Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

scholarly journals More than Garden Variety: Massive Vegetations from Infective Endocarditis

Pathogens ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 998
Author(s):  
Christopher Radcliffe ◽  
Joyce Oen-Hsiao ◽  
Matthew Grant
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intervention ◽  
Case Reports ◽  
Source Control ◽  
Valvular Regurgitation ◽  
Vancomycin Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
History Of

Infective endocarditis classically involves non-sterile vegetations on valvular surfaces in the heart. Feared complications include embolization and acute heart failure. Surgical intervention achieves source control and alleviates valvular regurgitation in complicated cases. Vegetations >1 cm are often intervened upon, making massive vegetations uncommon in modern practice. We report the case of a 39-year-old female with history of intravenous drug abuse who presented with a serpiginous vegetation on the native tricuspid valve and methicillin-resistant Staphylococcus aureus bacteremia. The vegetation grew to 5.6 cm by hospital day two, and she successfully underwent a tricuspid valvectomy. Six weeks of intravenous vancomycin therapy were completed without adverse events. To better characterize other dramatic presentations of infective endocarditis, we performed a systematic literature review and summarized all case reports involving ≥4 cm vegetations.

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