Infective endocarditis in an HIV-infected intravenous drug user

Infective endocarditis is a common complication among injecting drug users. Disease risk among these patients is increased by the spread of HIV infection. In the following article, we discuss the exceptional clinical presentation of a 28-year-old patient who used intravenous drugs (heroin) for 10 ye...

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Main Authors: Karolina Mėlinytė, Jurgita Savickaitė, Daiva Emilija Rekienė, Albinas Naudžiūnas, Aušra Burkauskienė, Laima Jankauskienė
Format: Article
Language:English
Published: Elsevier 2015-10-01
Series:Revista Portuguesa de Cardiologia (English Edition)
Online Access:http://www.sciencedirect.com/science/article/pii/S2174204915002226
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spelling doaj-79b44d73eec94cc7ad2870f2b77ae82c2020-11-24T22:09:55ZengElsevierRevista Portuguesa de Cardiologia (English Edition)2174-20492015-10-013410619.e1619.e5Infective endocarditis in an HIV-infected intravenous drug userKarolina Mėlinytė0Jurgita Savickaitė1Daiva Emilija Rekienė2Albinas Naudžiūnas3Aušra Burkauskienė4Laima Jankauskienė5Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, LithuaniaLithuanian University of Health Sciences, Faculty of Medicine, Kaunas, LithuaniaClinic of Internal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania; Corresponding author.Clinic of Internal Diseases, Lithuanian University of Health Sciences, Kaunas, LithuaniaInstitute of Anatomy, Lithuanian University of Health Sciences, Kaunas, LithuaniaClinic of Internal Diseases, Lithuanian University of Health Sciences, Kaunas, LithuaniaInfective endocarditis is a common complication among injecting drug users. Disease risk among these patients is increased by the spread of HIV infection. In the following article, we discuss the exceptional clinical presentation of a 28-year-old patient who used intravenous drugs (heroin) for 10 years, had been infected with HIV for seven years and as a complication had developed Staphylococcus aureus infective endocarditis.The patient came to the hospital in serious condition, complaining of bodily pain, swelling of the legs and general weakness. During hospitalization, besides infective endocarditis, she was also diagnosed with anemia, toxic hepatitis, renal failure, ascites, sepsis, and pneumonia. A completely disrupted tricuspid valve, damaged aortic valve, and fibrosis of the mitral valve were detected. Echocardiographic and radiologic data showed that the patient's condition continued to deteriorate day by day, with significant progression of heart failure, ejection fraction decreasing from 45% to 10%, and development of myocarditis, hydrothorax and pericarditis. However, this progressive worsening of the patient's condition ceased when vancomycin was administered. To the authors’ knowledge, this is the first such case described in the literature in which significant improvement was observed despite the patient's complex condition with associated complications. Resumo: A endocardite infecciosa é uma complicação comum entre os consumidores de drogas injetáveis. O risco desta doença nestes pacientes aumenta com a propagação da infeção do VIH. Neste artigo, discute-se a apresentação clínica de uma jovem doente que consumiu drogas intravenosas (heroína) durante dez anos e que há sete anos que está infetada pelo VIH. Para além disso, desenvolveu endocardite infecciosa causada por Staphylococcus aureus. De 28 anos de idade apresentou-se no hospital em estado grave, queixando-se de dores no corpo, pernas inchadas e de um estado geral de fraqueza.Durante o internamento, para além da endocardite infecciosa, foi-lhe também diagnosticado – anemia, hepatite tóxica, insuficiência renal, ascite, sepsis e pneumonia. Foram também detetadas interrupção total da válvula tricúspide, válvula aórtica danificada e fibrose da válvula mitral. De acordo com a avaliação ecocardiográfica e dados radiológicos, a situação da doente continuou a deteriorar-se: a insuficiência cardíaca progrediu significativamente, a fração de ejeção diminuiu de 45% para 10% e desenvolveram-se miocardite, hidrotórax e pericardite. No entanto, apesar da situação grave da doente progredir de modo contínuo, houve uma melhoria assim que lhe foi administrada vancomicina. De acordo com os autores, este será o primeiro caso clínico descrito na literatura que revelou uma melhoria significativa apesar da situação complexa da doente com demais complicações. Keywords: Infective endocarditis, HIV, Intravenous drug use, Tricuspid valve, Palavras-chave: Endocardite infecciosa, VIH, Utilização de fármaco intravenoso, Válvula tricúspidehttp://www.sciencedirect.com/science/article/pii/S2174204915002226
collection DOAJ
language English
format Article
sources DOAJ
author Karolina Mėlinytė
Jurgita Savickaitė
Daiva Emilija Rekienė
Albinas Naudžiūnas
Aušra Burkauskienė
Laima Jankauskienė
spellingShingle Karolina Mėlinytė
Jurgita Savickaitė
Daiva Emilija Rekienė
Albinas Naudžiūnas
Aušra Burkauskienė
Laima Jankauskienė
Infective endocarditis in an HIV-infected intravenous drug user
Revista Portuguesa de Cardiologia (English Edition)
author_facet Karolina Mėlinytė
Jurgita Savickaitė
Daiva Emilija Rekienė
Albinas Naudžiūnas
Aušra Burkauskienė
Laima Jankauskienė
author_sort Karolina Mėlinytė
title Infective endocarditis in an HIV-infected intravenous drug user
title_short Infective endocarditis in an HIV-infected intravenous drug user
title_full Infective endocarditis in an HIV-infected intravenous drug user
title_fullStr Infective endocarditis in an HIV-infected intravenous drug user
title_full_unstemmed Infective endocarditis in an HIV-infected intravenous drug user
title_sort infective endocarditis in an hiv-infected intravenous drug user
publisher Elsevier
series Revista Portuguesa de Cardiologia (English Edition)
issn 2174-2049
publishDate 2015-10-01
description Infective endocarditis is a common complication among injecting drug users. Disease risk among these patients is increased by the spread of HIV infection. In the following article, we discuss the exceptional clinical presentation of a 28-year-old patient who used intravenous drugs (heroin) for 10 years, had been infected with HIV for seven years and as a complication had developed Staphylococcus aureus infective endocarditis.The patient came to the hospital in serious condition, complaining of bodily pain, swelling of the legs and general weakness. During hospitalization, besides infective endocarditis, she was also diagnosed with anemia, toxic hepatitis, renal failure, ascites, sepsis, and pneumonia. A completely disrupted tricuspid valve, damaged aortic valve, and fibrosis of the mitral valve were detected. Echocardiographic and radiologic data showed that the patient's condition continued to deteriorate day by day, with significant progression of heart failure, ejection fraction decreasing from 45% to 10%, and development of myocarditis, hydrothorax and pericarditis. However, this progressive worsening of the patient's condition ceased when vancomycin was administered. To the authors’ knowledge, this is the first such case described in the literature in which significant improvement was observed despite the patient's complex condition with associated complications. Resumo: A endocardite infecciosa é uma complicação comum entre os consumidores de drogas injetáveis. O risco desta doença nestes pacientes aumenta com a propagação da infeção do VIH. Neste artigo, discute-se a apresentação clínica de uma jovem doente que consumiu drogas intravenosas (heroína) durante dez anos e que há sete anos que está infetada pelo VIH. Para além disso, desenvolveu endocardite infecciosa causada por Staphylococcus aureus. De 28 anos de idade apresentou-se no hospital em estado grave, queixando-se de dores no corpo, pernas inchadas e de um estado geral de fraqueza.Durante o internamento, para além da endocardite infecciosa, foi-lhe também diagnosticado – anemia, hepatite tóxica, insuficiência renal, ascite, sepsis e pneumonia. Foram também detetadas interrupção total da válvula tricúspide, válvula aórtica danificada e fibrose da válvula mitral. De acordo com a avaliação ecocardiográfica e dados radiológicos, a situação da doente continuou a deteriorar-se: a insuficiência cardíaca progrediu significativamente, a fração de ejeção diminuiu de 45% para 10% e desenvolveram-se miocardite, hidrotórax e pericardite. No entanto, apesar da situação grave da doente progredir de modo contínuo, houve uma melhoria assim que lhe foi administrada vancomicina. De acordo com os autores, este será o primeiro caso clínico descrito na literatura que revelou uma melhoria significativa apesar da situação complexa da doente com demais complicações. Keywords: Infective endocarditis, HIV, Intravenous drug use, Tricuspid valve, Palavras-chave: Endocardite infecciosa, VIH, Utilização de fármaco intravenoso, Válvula tricúspide
url http://www.sciencedirect.com/science/article/pii/S2174204915002226
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