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 Endocarditis: A Teachable Moment. JAMA Intern Med. 2017;177(7):1026–1027. doi:10.1001/jamainternmed.2017.1489
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