SHM Converge Scientific Abstract ePoster Gallery-Cavitary Pulmonary Lesions; A Manifestation of Right-Sided Infective Endocarditis in Intravenous Drug User

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This case describes a 29-year-old Hispanic man with intravenous drug use who presented confused, febrile, hypoxic, hypotensive, and encephalopathic. Imaging showed bilateral multifocal pulmonary infiltrates and cavitary nodular lesions, initially suggesting severe necrotizing pneumonia. Blood cultures grew methicillin-susceptible <em>Staphylococcus aureus</em> (MSSA), and transthoracic echocardiography revealed a large tricuspid valve vegetation (1.6 × 1.5 cm), confirming right-sided infective endocarditis with septic pulmonary emboli. Additional findings included hepatosplenomegaly, acute kidney injury progressing to renal failure requiring hemodialysis, HIV infection with high viral load but preserved CD4 count, and hepatitis C antibody positivity. Despite broad-spectrum antibiotics later narrowed to IV oxacillin, respiratory failure worsened, requiring mechanical ventilation and vasopressors, and the patient ultimately died.

The discussion emphasizes that right-sided infective endocarditis accounts for about 10% of IE cases and is most often seen in people who inject drugs. Unlike left-sided IE, it may lack classic murmurs or systemic emboli and instead present with pulmonary symptoms due to septic embolization. Cavitary lung lesions on chest imaging in an intravenous drug user should strongly raise suspicion for right-sided IE. Because delayed diagnosis and treatment worsen outcomes, prompt recognition, blood cultures, and echocardiography are critical.

The authors conclude that clinicians should consider right-sided infective endocarditis in patients with injection drug use, fever, bacteremia, respiratory symptoms, and pulmonary infiltrates or cavitary lesions.

Asset Subtitle

Safeera Javed

Meta Tag

Author List Noorulaain Bhatti, Safeera Javed

Category Clinical Vignettes

Concept Cavitary Lung Lesion

Concept Septic Pulmonary Emboli

Concept Right-sided Infective Endocarditis

Concept Intravenous Drug Use

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Safeera Javed

Track Adult

Keywords

right-sided infective endocarditis

intravenous drug use

Staphylococcus aureus

septic pulmonary emboli

tricuspid valve vegetation

cavitary lung lesions

methicillin-susceptible MSSA

blood cultures

echocardiography

respiratory failure

Cavitary Lung Lesion

Septic Pulmonary Emboli

Right-sided Infective Endocarditis

Intravenous Drug Use

Blood Culture