A young adult with severe opioid use disorder (OUD) secondary to long-standing intravenous (IV) heroin use was admitted to the hospital with encephalopathy, respiratory failure, and septic shock. Two sets of blood cultures were positive for methicillin-sensitive Staphylococcus aureus, as were cultures of his cerebrospinal fluid. He was found to have mitral valve infective endocarditis with a subannular abscess, acute mitral regurgitation, and septic cerebral emboli. He underwent mitral valve replacement and placement of a pericardial patch. During the hospitalization he was diagnosed as having chronic hepatitis C virus infection, which he most likely contracted from sharing needles. Six weeks of appropriate antibiotics were completed outside of the hospital through a peripherally inserted central catheter (PICC) under the supervision of a family member. During this hospitalization, no treatment for OUD was offered or initiated.
Serota DP, Kraft CS, Weimer MB. Treating the Symptom but Not the Underlying Disease in Infective EndocarditisA Teachable Moment. JAMA Intern Med. Published online May 15, 2017. doi:10.1001/jamainternmed.2017.1489