Fallberichte

Abstract

37 KB  Full paper 1 since May 2005

Patient history and clinical data: A 39-year-old female patient with a known drug addiction was admitted as an inpatient with a parotid abscess. Despite antibiotic treatment, her condition deteriorated. At the time of transfer to our hospital, she was somnolent, showed tachycardia and tachypnea with a body temperature of 40 degrees Celsius and blood pressure of 80/60 mmHg.

Test Results: The ECG showed right heart stress, the echocardiogram demonstrated pericardial effusion and vegetation of the tricuspid valve which prolapsed up to two cm into the right atrium. The Doppler ultrasound showed a medium grade tricuspid regurgitation. The chest x-ray showed circular thickenings and an enlarged heart. Aerobic and anaerobic blood cultures contained Staphylococcus aureus.

Clinical Course: The diagnosis of a right heart endocarditis in this female patient with an addiction to cocaine and opioids was established. She was treated with intravenous antibiotics for eight weeks, to prevent withdrawal symptoms methadone was given. Subsequent complications occurred: embolic events to the lungs, kidneys and brain with temporary eye muscles paralysis. The severe right heart stress led to right heart failure. Three and a half months of hospital treatment were required before the patient’s general condition was stable enough for a detoxification program. So far she has been off drugs for seven months with a minor heart insufficiency (NYHA I).

Conclusions: Patients with known intravenous drug addiction admitted for something other diseases, an important differential diagnosis should always be the possibility of endocarditis. The effect of opiates can suppress major symptoms and thus lead to false assessment of the severity of the disease.