Birsic George W, Fulcher James W, Fiester Steven E
Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC.
Am J Forensic Med Pathol. 2019 Mar;40(1):72-76. doi: 10.1097/PAF.0000000000000445.
This case report details the unique cause of death of a 37-year-old Caucasian woman with a history significant for intravenous drug abuse. Before her death, she complained of extremity weakness and pain. Although her death was discovered to be the result of endocarditis, her symptoms were similar to that of a stroke. Autopsy revealed a large endocardial vegetation infecting both the tricuspid and mitral valves and a patent foramen ovale. The subsequent embolization of this vegetation caused blockages in the lungs, liver, and brain. An acute embolization of these vegetations to the bilateral middle cerebral arteries is the cause of the stroke presentation. Other comorbidities, such as cardiomegaly, microscopic evidence of myocardial infarction, and atherosclerotic disease, also contributed to the cause of death. As the opioid crisis continues in the United States, it is important to review cases involving the effects of drug use. The multiple interactions between endocarditis and the aforementioned conditions are documented to not only serve as references for future autopsies but also for the treatment of patients who have similar symptoms and comorbidities.
本病例报告详细介绍了一名37岁有静脉注射吸毒史的白人女性独特的死亡原因。在她去世前，她抱怨肢体无力和疼痛。尽管发现她的死亡是心内膜炎所致，但其症状与中风相似。尸检发现一个大的心内膜赘生物，累及三尖瓣和二尖瓣，还有一个卵圆孔未闭。该赘生物随后的栓塞导致肺部、肝脏和脑部出现阻塞。这些赘生物急性栓塞至双侧大脑中动脉是出现中风症状的原因。其他合并症，如心脏肥大、心肌梗死的微观证据和动脉粥样硬化疾病，也促成了死亡原因。随着美国阿片类药物危机的持续，审查涉及吸毒影响的病例很重要。记录下心内膜炎与上述病症之间的多种相互作用，不仅可为未来的尸检提供参考，也可为有类似症状和合并症的患者的治疗提供参考。
