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Infective Endocarditis in Intravenous Drug Abuse - a Clinical Case

Violeta Dimitrova, Joana Andonova, Viktor Urbanchich, Vesela Zlateva, Maria Dimova

Abstract

Introduction: Infective endocarditis (IE) is an inflammation of the endocardium affecting most commonly the heart valves. IE in intravenous drug users (IVDU) is associated with high mortality rates and is one of the complications of intravenous drug abuse. Both right-sided and left-sided involvement of the valves is reported with left-sided pathology leading to more severe complications. Predominant microorganisms associated with this condition in IVDU include Staphylococcus and fungal species due to the compromised immune system of that particular group of patients.

Materials and Methods: This is a clinical case of a 32-year-old male with a 15-year history of intravenous heroin drug abuse, a right middle cerebral artery brain stroke from February, 2015 and chronic hepatitis type C. The patient was admitted to a hospital with symptoms of intermittent fever with duration of a few months, which reached 38 °C in the last 10 days, difficulty talking and left leg numbness from two days.

Results: After a number of clinical examinations and laboratory tests were carried out, the patient was diagnosed with subacute left middle cerebral artery brain stroke, infective endocarditis with Staphylococcus aureus and grade IV aortic regurgitation. Treatment with antibiotics including Vancomycin, Ceftriaxone, Gentamicin and Ciprofloxacin was immediately initiated, following stabilization of the patient who was to be considered for further surgical treatment having in mind the high-risk group he represented.

Conclusions: This clinical case is an example of the severe complications to which drug abuse may lead and the difficulties physicians may experience in the management and follow-up of such high risk patients.  


Keywords

infective endocarditis, high-risk patients, intravenous drug abuse


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