This article describes the case of infective endocarditis in a 32-year-old IV drug user. The patient was currently under treatment with antibiotics for 6 weeks. And doctors advised mitral valve repair and annuloplasty because of severe mitral regurgitation (MR) and tricuspid regurigitation (TR), 9 months ago.
He presented to the ER with complaints of fever, lethargy and poor appetite that had worsened over a week’s time. The patient’s temperature was 102°F. Physical examination revealed the systolic murmur best at the apex beat with tachycardia of 118 beats per minute. Blood culture grew gram-positive cocci in pairs, identified as methicillin-resistant Staphylococcus aureus. Doctors started the patient on vancomycin and piperacillin/tazobactam. Transthoracic echocardiopgraphy was significant for vegetation in the mitral valve with severe MR and TR. Transesophageal echocardiography confirmed the diagnosis.
Doctors advised mitral valve repair and annuloplasty.
The patient’s post surgery period was uneventful. He showed clinical improvement and was discharged on a 6-week course of vancomycin. However, 9 months later, the patient was back to the emergency with complaints of shortness of breath and fatigue. On questioning the patient he reported that he had been using intravenous drugs after completion of antibiotics. He also reused needles after washing them. Physical examination showed that the patient was febrile with a temperature 100.7 F with tachypnoea and a respiratory rate of 27 breath per minute.
Auscultation of the lungs was unremarkable. There was no jugular venous reflux, pedal oedema or signs of skin lesions. Doctors started the patient on vancomycin and cefepime. Blood culture of the patient was positive for B. cepacia in one bottle. Given the findings, the patient underwent a mitral valve replacement and tricuspid valve annuloplasty. The patient’s postoperative period was uneventful. The patient’s pathology report was positive for fibrous tissue and fibrinous material with presence of inflammatory cells. Based on the findings, doctors diagnosed the patient with infective endocarditis.
Treatment included intravenous levofloxacin.
The patient was discharged after a week of completing 6 weeks of intravenous antibiotics. Repeated blood cultures were negative for any growth of organisms. He was discharged to a rehabilitation centre. The patient remained free of any events at 2 months follow-up. There were no other symptoms of infection. Similarly, he tolerated exercise well and denied using any drugs after discharge.
A Rare Culprit of Infective Endocarditis in an IV Drug User: Burkholderia cepacia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481116/