A 21-year-old woman with a history of multiple hospital admissions for sepsis secondary to injection heroin use presented to the hospital with a right thigh abscess and dyspnea. Her diagnostic workup revealed pulmonic valve endocarditis, with both abscess and blood cultures growing methicillin-sensitive Staphylococcus aureus. The patient developed sepsis with respiratory failure and was intubated. Despite 11 days of treatment with antibiotics, her condition worsened and necessitated pulmonic valve replacement. She improved after surgery and received intravenous antibiotics for 6 weeks. She also received 220 morphine milligram equivalents for postoperative pain. Based on concerns that she would be at high risk to use her peripherally inserted central catheter to inject heroin as an outpatient, the decision was made to keep her hospitalized while completing the course of antibiotics.
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Raheemullah A, Lembke A. Initiating Opioid Agonist Treatment for Opioid Use Disorder in the Inpatient Setting: A Teachable Moment. JAMA Intern Med. 2019;179(3):427–428. doi:10.1001/jamainternmed.2018.6749
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