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

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.

Surgical Treatment of Ruptured Infectious Femoral Pseudoaneurysms Caused By Intravenous Drug Abuse: A Nonemergent (Postponed) Operation Pattern May Be a Possible Alternative

Objective: To evaluate the possibility of surgical treatment of ruptured infectious femoral pseudoaneurysms caused by intravenous drug abuse in a nonemergent operation pattern, with retrospective analysis of clinical data and experience at a single center.Methods: Clinical data of 85 consecutive patients presenting with groin area active or recent hemorrhage due to a ruptured infectious femoral artery pseudoaneurysm related to drug abuse who were treated in the First Hospital of Changsha, China, from July 2008 to June 2020 were collected and analyzed.Results: A total of 74.1% of patients presented with active hemorrhage, and 36.5% presented with significant hypotension at admission. The average interval between arrival and operation was 34.7±4.7 hours. Vital physiological parameters and overall situation improved significantly after sufficient preoperative preparation. Satisfactory hemostasis can be achieved by bandage compression or local skin suture. No case was transferred to urgent operation due to severe bleeding, and 1 postoperative death case was observed in the cohort. The main operative- and postoperative-related indicators were satisfactory and close to those in the emergent operation pattern.Conclusion: While emergent or urgent operation is the mainstream surgical treatment for ruptured infectious femoral pseudoaneurysms, nonemergent (postponed) operation with sufficient preoperative preparation might also be an acceptable and comparable choice in some cases.

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.

A painful red eye in an intravenous drug abuser: When not everything is what it seems

Introduction Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. Case Description We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. Conclusion Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.