Abstract
Background
Infective endocarditis is associated with significant morbidity and mortality, despite
advances in diagnosis and treatment strategies. Injecting drug users are particularly
at risk of endovascular infections, especially with multi-resistant and virulent microorganisms.
Typically, patients with endocarditis present with constitutional symptoms, such as
high fever and malaise combined with cardiorespiratory symptoms of valvular failure
or emboli, such as septic pulmonary embolism.
Case Report
A 33-year-old female with a history of peptic ulcer disease presented to the emergency
department with 3 days of increasing unilateral calf pain and swelling. There was
no history of trauma or immobilization, no fever or clinical signs of sepsis or cardiopulmonary
symptoms. A history of recent i.v. amphetamine injection in the forearm was elicited
and empiric treatment for endovascular infection was commenced. Workup revealed methicillin-resistant
Staphylococcus aureus mitral papillary endocarditis with gastrocnemius pyomyositis, multi-joint septic
arthritis, and brain abscesses. After a 60-day inpatient stay, including intensive
care admission for septic shock, the patient made a good recovery.
Why Should an Emergency Physician Be Aware of This?
The incidence of injecting drug use is increasing, and these patients are at risk
of severe invasive infections with multi-resistant organisms. The emergency physician
is most often responsible for the initial workup and treatment of patients with suspected
infective endocarditis, with timely collection of blood cultures and appropriate antibiotics
being essential interventions. This case highlights that even without fever, murmurs,
or constitutional symptoms, severe multisystem infections from endocarditis can occur.
Keywords
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Article info
Publication history
Published online: April 24, 2019
Accepted:
March 4,
2019
Received in revised form:
February 12,
2019
Received:
January 3,
2019
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. All rights reserved.
