SHM Converge Scientific Abstract ePoster Gallery-A Case of a Spontaneous Pneumothorax With Non-Valvular Right-Sided Endocarditis

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This case report describes a rare complication of infective endocarditis: spontaneous pneumothorax. A 28-year-old woman with intravenous drug use and untreated hepatitis C presented with painful skin lesions, myalgias, pleuritic chest pain, and recent heroin use. She was tachycardic and had track marks, multiple tender erythematous areas consistent with cellulitis, a systolic murmur, and decreased breath sounds on the right.<br /><br />Laboratory tests showed leukocytosis with bandemia and elevated lactate and liver enzymes. CT chest revealed bilateral cavitary pulmonary nodules consistent with septic emboli, along with a moderate right pneumothorax and small pleural effusion. She was admitted for sepsis and started on broad-spectrum antibiotics. The pneumothorax was treated conservatively with oxygen and later resolved on follow-up imaging.<br /><br />Echocardiography showed a large echogenic mass in the right atrium, separate from the tricuspid valve, and blood cultures grew MRSA. Transesophageal echocardiogram confirmed a mobile right atrial lesion, thought to be an infected thrombus or non-valvular right-sided endocarditis. Cardiothoracic surgery recommended medical treatment rather than surgery, including anticoagulation. During hospitalization, she developed a posterior thigh abscess that required drainage, but otherwise improved and completed six weeks of antibiotics.<br /><br />The report emphasizes that spontaneous pneumothorax is an uncommon but important complication of septic pulmonary emboli from right-sided infective endocarditis, especially in intravenous drug users. Clinicians should consider pneumothorax in patients with IV drug use who present with acute shortness of breath or pleuritic chest pain.

Asset Subtitle

Neela Qadir

Meta Tag

Author List Balaji Pratap, Dina Yusupova, Henri-Robert Delbeau, Marioly Armada Munoz, Neela Qadir, Riliwan Adekiigbe, Yuriy Takhalov

Category Clinical Vignettes

Concept Pneumothorax

Concept Infective Endocarditis

Concept Intravenous Drug Use

Concept Blood Culture

Concept Antibiotics

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Neela Qadir

Track Adult

Keywords

infective endocarditis

spontaneous pneumothorax

septic pulmonary emboli

intravenous drug use

MRSA bacteremia

right atrial lesion

cavitary pulmonary nodules

pleuritic chest pain

sepsis

right-sided endocarditis

Pneumothorax

Infective Endocarditis

Intravenous Drug Use

Blood Culture

Antibiotics