Panduranga Prashanth, Al-Abri Seif, Rajarao Mamatha Punjee
Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Department of Infectious Diseases, Royal Hospital, Muscat, Sultanate of Oman.
J Cardiovasc Echogr. 2017 Jan-Mar;27(1):14-16. doi: 10.4103/2211-4122.199059.
A 56-year-old male, who is an active intravenous drug abuser (IVDA) (heroin) with a history of diabetes, hypertension, chronic kidney disease, and hepatitis C-related liver cirrhosis, presented with generalized anasarca, bilateral pneumonic infiltrations, and heart failure. His blood cultures were positive for and were treated with antibiotics. Echocardiogram showed multiple uncommon manifestations of left-sided endocarditis. Surprisingly, he did not have right-sided involvement. Furthermore, echocardiogram revealed undiagnosed large atrial septal defect suggesting a paradoxical seeding of infective vegetation. This case illustrates the uncommon manifestations of endocarditis in an IVDA and indicates that it is very important to check comprehensively for an atrial septal defect or patent foramen ovale or any shunt in such high-risk patients who may be at risk for left-sided endocarditis which is catastrophic when compared to right-sided endocarditis. If detected early in IVDA patients, these shunts need to be closed to prevent paradoxical embolism of vegetation.
一名56岁男性，是活跃的静脉注射吸毒者（IVDA，使用海洛因），有糖尿病、高血压、慢性肾脏病和丙型肝炎相关肝硬化病史，出现全身水肿、双侧肺部浸润和心力衰竭。他的血培养 呈阳性，接受了抗生素治疗。超声心动图显示左侧心内膜炎有多种罕见表现。令人惊讶的是，他没有右侧受累。此外，超声心动图显示未诊断出的大型房间隔缺损，提示感染性赘生物的反常播散。该病例说明了IVDA中的心内膜炎的罕见表现，并表明对于这类可能有左侧心内膜炎风险（与右侧心内膜炎相比后果严重）的高危患者，全面检查房间隔缺损、卵圆孔未闭或任何分流非常重要。如果在IVDA患者中早期发现这些分流，需要进行封堵以防止赘生物的反常栓塞。
