Tricuspid Valve Endocarditis with Septic Pulmonary Emboli in a Drug Addict

Tricuspid and mitral endocarditis due to methicillin-resistantStaphylococcus aureusexhibiting vancomycin-creep phenomenon

“…Common complications of RIE are pulmonary emboli, pulmonary infarction, pulmonary abscesses, pneumothoraces and purulent pulmonary effusions. Rarely, pulmonary hypertension, right heart failure (RHF), severe TR and obstruction of pulmonary circulation due to multiple pulmonary emboli, can occur 5. Concurrent left-sided IE is seen in about 13% of patients and portends a poorer prognosis 7.…”

“…TTE is a good screening modality (sensitivity 40–63%) due to the anterior location of the TV as well as the large vegetations associated with RIE. TEE is a more sensitive (sensitivity 90–100%) imaging tool, especially for endocarditis-related abscesses as well as associated left-sided involvement 5 12…”

“…Surgical therapy in these patients is frequently life-saving and is required in 25–50% of cases 5 13 14. European Society of Cardiology guidelines generally recommend avoiding surgery for RIE, except in the following situations: (1) RHF secondary to severe TR with poor response to diuretic therapy; (2) IE caused by organisms that are difficult to eradicate (eg, fungi), or bacteraemia for at least 7 days (eg, S. aureus , Pseudomonas aeruginosa ) despite adequate antimicrobial therapy; and (3) TV vegetations >20 mm that persist after recurrent pulmonary emboli with or without concomitant RHF.…”

“…Intravenous drug use (IVDU) is a common risk factor for IE, with poor hygiene and unsafe injection practices especially increasing the risk 4 5. Multiple organisms have been reported to cause IE, however, in the early 21st century, a high rate of Staphylococcus aureus infections have been noted 5 6. We report a case of a young patient who developed concomitant TVIE and mitral valve (MV) IE with S. aureus.…”

“…Right-sided IE (RIE) commonly affects the tricuspid valve (TV) and constitutes 5–10% of all cases of IE 4. Intravenous drug use (IVDU) is a common risk factor for IE, with poor hygiene and unsafe injection practices especially increasing the risk 4 5. Multiple organisms have been reported to cause IE, however, in the early 21st century, a high rate of Staphylococcus aureus infections have been noted 5 6.…”