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A case of tricuspid valve infective endocarditis in intravenous drug use

A 50-year-old woman presented to a regional hospital with joint pain for up to 5 days. On examination, she was febrile, tachycardic and hypotensive (heart rate of 120 bpm, blood pressure of 94/64 mmHg). She had multiple hot and swollen joints, with an erythematous rash covering the back and abdomen. The patient is an active intravenous drug user (IVDU), with regular ICE (crystal methamphetamine) injections to the groin. A computed tomography (CT) of the brain and cervical spine showed no focal intracranial abnormalities or cervical fracture. A CT of the chest abdomen and pelvis revealed an enlarged filling defect within the inferior vena cava (IVC). Multifocal pulmonary lesions were identified, which included cavitation with air fluid level, consistent with septic pulmonary emboli (Figure 1). A blood test revealed the presence of the gram-positive cocci bacteremia, Staphylococcus aureus. Therapeutic management with intravenous antibiotics (Cephazolin, Gentamicin, Vancomycin, Metronidazole) was commenced. The patient was transferred to the Cardiology Unit at a metropolitan hospital for further assessment and treatment. A transthoracic echocardiogram (TTE) was requested to exclude infective endocarditis (IE) and evidence of right heart strain secondary to the pulmonary emboli.