Winkle Sean M, Gaballa Salem, Memon Areeka, Miller Jeremy B, Curfiss Ryan
Internal Medicine, LewisGale Medical Center, Salem, USA.
Osteopathic Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Cureus. 2020 Aug 25;12(8):e10010. doi: 10.7759/cureus.10010.
bacteremia is common in patient populations with a history of intravenous drug use (IVDU), but it rarely causes infective endocarditis. We are reporting a 27-year-old female with a medical history significant for IVDU and hepatitis C virus infection who presented to the emergency department complaining of fever and shortness of breath. Computed tomography of the chest with intravenous (IV) contrast revealed extensive bilateral pulmonary infiltrates with multiple cavitary lesions. The patient was treated with IV vancomycin and piperacillin/tazobactam. Blood culture grows methicillin-sensitive (MSSA) and , both sensitive to cefepime/meropenem. Transesophageal echocardiogram revealed 3.4 x 2 cm tricuspid valve vegetation. Cardiothoracic surgery was consulted, who recommended transcatheter aspiration with the AngioVac® system (AngioDynamics Inc., Latham, NY). Post-procedure transesophageal echocardiogram revealed a significant reduction of vegetation size. Vegetation tissue culture grew MSSA and . The repeated blood culture revealed no growth, and the patient significantly improved clinically. She completed a six-week course of IV meropenem as an inpatient until she was discharged home.
菌血症在有静脉药物使用史（IVDU）的患者群体中很常见，但很少导致感染性心内膜炎。我们报告一名27岁女性，有IVDU和丙型肝炎病毒感染病史，因发热和呼吸急促到急诊科就诊。静脉注射（IV）造影剂的胸部计算机断层扫描显示双侧广泛肺部浸润，有多个空洞性病变。患者接受了静脉注射万古霉素和哌拉西林/他唑巴坦治疗。血培养生长出对甲氧西林敏感的金黄色葡萄球菌（MSSA），且对头孢吡肟/美罗培南均敏感。经食管超声心动图显示三尖瓣有3.4×2厘米的赘生物。咨询心胸外科后，其建议使用AngioVac®系统（AngioDynamics公司，纽约州拉瑟姆）进行经导管抽吸。术后经食管超声心动图显示赘生物大小显著减小。赘生物组织培养生长出MSSA。重复血培养无细菌生长，患者临床症状明显改善。她作为住院患者完成了为期六周的静脉注射美罗培南疗程，直至出院回家。
