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Teachable Moment
May 15, 2017

Treating the Symptom but Not the Underlying Disease in Infective EndocarditisA Teachable Moment

Author Affiliations
  • 1Division of Infectious Diseases, Emory University, Atlanta, Georgia
  • 2Department of Pathology, Emory University, Atlanta, Georgia
  • 3Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland
  • 4St Peter’s Addiction Recovery Center, St Peter’s Health Partners, Albany, New York
JAMA Intern Med. Published online May 15, 2017. doi:10.1001/jamainternmed.2017.1489

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.

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