1Department of Internal Medicine Kyushu Koseinenkin Hospinal, 2Research Institute for Diseases of the Chest Kyushu University Faculty of Medicine
Drug addict, Right-sided infective endocarditis, Two-dimensional echocardiography
We report a case of right-sided infective endocarditis in an intravenous drug addict. A 20-year-old woman with a history of intravenous drug addiction was admitted to this institution with fever, nonproductive cough, chest pain, and exertional dyspnea. Chest roentgenograms on admission showed multiple patchy infiltrates with cavitations in the lung field. A perfusion lung scan using 99m Tc-labeled macroaggregated albumin revealed multiple perfusion defects, suggesting multiple pulmonary emboli. Marked leukocytosis and hypoxemia were detected on laboratory examination. Staphylococcus aureus was isolated in blood cultures and transbronchial lavage fluid collected from a pulmonary infiltrate. Two-dimensional echocardiography revealed tricuspid valvular vegetations. These findings led to a diagnosis of right-sided endocarditis with septic pulmonary emboli. Symptoms and laboratory findings improved within 2 weeks of therapy with 2 g/day of imipenem/cilastatin and 30 mg of tobramycin every 6 hours. The patient was discharged after having received antibiotic therapy for 2 months. Two-dimensional echocardiography made a rapid diagnosis possible.