What’s Your Diagnosis? Infective Endocarditis in the ED: Recognition, Diagnosis, and Treatment
August 21, 2020
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Supraventricular Tachydysrhythmias in the Emergency Department right.
Case Presentation: Infective Endocarditis in the ED: Recognition, Diagnosis, and Treatment
A 25-year-old man presents to the ED with general malaise and fever for the preceding 3 weeks. He was seen recently at an outpatient clinic, diagnosed with pneumonia, and treated with azithromycin; however, he continues to have fevers. His history is remarkable for heroin addiction with recurrent treatment in rehabilitation over the past 3 years.
He is ill-appearing, with a temperature of 39?C (102.2?F); heart rate, 120 beats/min; blood pressure, 100/60 mm Hg; respiratory rate, 26 breaths/min; and oxygen saturation of 90% on room air. He has diffuse crackles bilaterally; you do not auscultate any heart murmurs. Chest x-ray reveals the presence of multifocal infiltrates. Broad-spectrum antibiotics are administered, and the patient is admitted to the hospital with a diagnosis of multifocal pneumonia and sepsis. The more you contemplate the case, though, you wonder whether there is a diagnostic test that could have been done…
The 25-year-old patient was admitted for sepsis and multifocal pneumonia. Blood cultures grew out MRSA in 2 of 2 bottles. Empiric antibiotics were begun in the ED and cardiac echo demonstrated a large tricuspid vegetation. Case management consultation occurred early, given the patient?s past visits for IV drug use-related complications. Following his hospitalization, he was released to a drug rehabilitation program as part of the terms of his treatment.