Elkattawy Sherif, Alyacoub Ramez, El-Feki Iman, Fichadiya Hardik, Appiah-Kubi Edmund, Romero Jesus, Guo Xutong, Edward William
Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA.
Internal Medicine, St George's University, West Indies, GRD.
Cureus. 2022 Apr 11;14(4):e24027. doi: 10.7759/cureus.24027. eCollection 2022 Apr.
Infective endocarditis is a multisystem disease. Tricuspid valve endocarditis is frequently seen in patients with intravenous (IV) drug users. Cavitating lung nodules predominantly in a peripheral location in IV drug users indicate the possibility of septic emboli. Large vegetation and persistent bacteremia with septic embolic phenomena are the most common indication for surgery. We present a case of a 62-year-old male with a history of IV drug use who presented with epigastric abdominal pain, pleuritic chest pain, and shortness of breath. CT chest showed cavitating lung nodules suggestive of septic pulmonary emboli. A transesophageal echocardiogram (TEE) showed tricuspid valve vegetation despite a normal transthoracic echocardiogram. The patient was treated with intravenous antibiotics. He was deemed a poor surgical candidate; therefore, he was transferred to a tertiary center for AngioVAC (AngioDynamics, Latham, New York).
感染性心内膜炎是一种多系统疾病。三尖瓣心内膜炎常见于静脉注射吸毒者。静脉注射吸毒者中主要位于外周的空洞性肺结节提示存在脓毒性栓子的可能性。巨大赘生物和伴有脓毒性栓子现象的持续性菌血症是最常见的手术指征。我们报告一例62岁男性，有静脉注射吸毒史，出现上腹部腹痛、胸膜炎性胸痛和呼吸急促。胸部CT显示有空洞性肺结节，提示脓毒性肺栓塞。经食管超声心动图（TEE）显示三尖瓣赘生物，尽管经胸超声心动图正常。该患者接受了静脉抗生素治疗。他被认为手术风险高；因此，他被转至三级中心接受AngioVAC（AngioDynamics公司，纽约州拉瑟姆）治疗。
