Drug use-related right-sided infective endocarditis complicated by empyema and bronchopleural fistula

Abstract

Right-sided infective endocarditis is frequently accompanied by septic pulmonary emboli, which may result in a spectrum of respiratory complications. We present the case of a 25-year-old woman diagnosed with infective endocarditis secondary to intravenous drug use. During a long and arduous hospital course, the patient developed empyema with bronchopleural fistula, representing severe but uncommon sequelae that may arise from this disease process. She was treated with several weeks of antibiotics as well as surgical thorascopic decortication and parietal pleurectomy.

Paradoxical embolisation to the brain in right-sided infective endocarditis and patent foramen ovale in a pregnant woman

“…Left-sided IE is more commonly associated with embolisation to the central nervous system and systemic circulation, while RSIE is often accompanied by septic pulmonary emboli 3 4. Rarely, paradoxical embolisation can occur in RSIE, usually in the setting of an atrial septal defect and shunting.…”

“…Though left-sided IE still represents the majority of endocarditis cases in the general population and pregnant patients, the decrease in rheumatic heart disease and increased use of injection drugs have resulted in a steady increase in right-sided involvement. Right-sided IE (RSIE) is typically associated with septic pulmonary emboli and related pulmonary complications 3. However, in the presence of a right-to-left intracardiac shunt, paradoxical embolisation into the systemic circulation can occur 4 5.…”