Both-sided native valve infective endocarditis in a drug addict with incidental pneumoconiosis
Introduction
Apart from morbidity and mortality caused by drug over-dosage, the intravenous drug users (IDU) are prone to local and systemic infections. In addition to infections from human immunodeficiency virus and hepatitis B/C viruses, infective endocarditis (IE) is another dreaded and potentially fatal condition that occurs in such individuals.1 IE is characterized by thrombus deposition over the surfaces of not only native normal or diseased heart valves and mural endocardium, but also over prosthetic devices deployed with the cardiovascular system.2 It is caused by several microbial pathogens and in general population, IE tends to more common in the left side of the heart. However, in patients with a history of intravenous drug abuse, it affects the normal right-sided structures.3 Multisite and/or both-sided IE are extremely rare. We report an autopsied case, where large vegetations were seen on both sides of the heart with an additional clinically occult addiction-related pulmonary pathology.
Section snippets
Case report
A 24-year-old male was admitted in the Medical Intensive Care Unit of our tertiary care center with complaints of high-grade fever with chills for the past seven days. This was then associated with progressive dyspnea, palpitation, pain in the left lower limb and altered sensorium since four days. He had a habit of substance abuse (heroin sniffer and occasional intravenous abuse, exact details and duration were not available). On general examination, patient was afebrile with a pulse rate of
Discussion
Heroin is an opioid drug that is synthesized from morphine, a naturally-occurring substance extracted from the seed pod of the Asian poppy plant. According to the UN report, there may be a million heroin addicts in India, but unofficially there are as many as five million.4 Heroin can be injected, smoked or inhaled by snorting or sniffing. Apart from the deleterious effects of the drug, other manifestations may also be related to adulterants added to increase volume and weight. In this report,
References (14)
- et al.
A systematic review of injecting-related injury and disease among people who inject drugs
Drug Alcohol Depend
(2017) - et al.
Native valve right sided infective endocarditis
Eur J Intern Med
(2013) - et al.
Extensive fulminant multivalvular infective endocarditis
JACC Cardiovasc Imag
(2009) - et al.
Echocardiographic findings suggestive of infective endocarditis in asymptomatic Danish injection drug users attending urban injection facilities
Am J Cardiol
(2014) - et al.
The pulmonary pathology of illicit drug and substance abuse
Curr Diagn Pathol
(2004) - et al.
The large spectrum of pulmonary complications following illicit drug use: features and mechanisms
Chem Biol Interact
(2013) - et al.
Infective endocarditis epidemiology over five decades: a systematic review
PLoS One
(2013)