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

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.

Opioid-related hospitalizations and intravenous drug users: Sociodemographic, spatial, and comorbid associations among hospital inpatients and community-based harm reduction organization participants

Objective: To provide an updated analysis of opioid-related injuries in Nevada and provide a first-time analysis of the intravenous drug user (IDU) population within Clark County.Design: Cross-sectional study.Setting: Center for Health Information Analysis (CHIA) database and IDU data from Trac-B Exchange (Trac-B).Participants: Patients hospitalized for opioid-related causes (n = 9,064) and participants from Trac-B.Main outcome measure(s): Variables assessed included age, gender, and race/ethnicity. Zip codes were retrieved to find differences in geographical usage patterns of hospital or sterile injection equipment (SEP) sites. Contingency tables were utilized to determine the frequency of comorbidities. Additionally, GIS was used to investigate potential spatial patterns of interest.Results: Totally 5,268 out of the 9,064 opioid-related cases reported in Nevada were Clark County residents. The highest frequency for comorbidities associated with opioid-related hospitalizations (ORHs) included: infections, chronic bodily pain, and malnutrition. There was a higher proportion of 18-35-year-olds who used SEPs as compared to hospitals and a higher proportion of individuals aged 36 years or older who used hospitals as compared to using SEPs. Of the nearly 100 zip codes in Clark County, six showed a disproportionally high frequency of ORHs, and three comprised the majority of injection drug use.Conclusions: There is an opioid epidemic in Nevada that has contributed to addiction, heroin usage, injection drug use, and transmission of bloodborne diseases. Understanding the ORHs and intravenous drug use trends can help guide the development of program interventions.

Necrotizing Fasciitis Causing Complete Femoral Vessels Necrosis and Thrombosis in an Intravenous Drug Abuser: A Case Report

Background: Intravenous drug abuse is an anciently known health and social problem worldwide. The nonsterile application of addicting drugs leads to severe life-threatening vascular complications. The femoral triangle is an easy target for this purpose. Groin necrotic fasciitis (NF) with vessel necrosis is a challenging diagnosis that requires prompt treatment. Case Report: A 44-year-old male intravenous drug user presented for a left groin pain. He was diagnosed by computed tomography scan to have necrotizing fasciitis. Urgent debridement was performed and identified infected and necrotic ruptured femoral vessels without active bleeding. Debridement with vessel ligation was performed, and delayed revascularization was planned. The patient was admitted six weeks later with a left fifth toe necrosis and delayed arterial revascularization was performed via extra-anatomic trans-obturator ilio-femoral anastomosis. The patient had a favorable follow-up. Conclusion: NF in intravenous drug abusers should always be taken into consideration when a patient presents with groin pain and swelling. Urgent surgical control should be established. Extra-anatomical trans-obturator ilio-femoral anastomosis is a good option for revascularization.