PURPOSE: Recent reports indicate that septic pulmonary embolism (SPE) among illicit drug users is now rare(1) and although endocarditis(IE)among injection drug users (IDU) is considered a low risk disease some patients may have high morbidity and poor outcome. We present the results of our retrospective review aimed at describing clinical course of patients with SPE due to IE.
METHODS: We reviewed the medical records of consecutive IDU admitted to Detroit Receiving Hospital between January 2002 and December 2006 for IE and SPE.
RESULTS: We identified 90 patients who had IE and 36 (40%) had SPE. Complete records were available for 33 patients(mean age 46yrs), One had a prosthetic valve, 9 a prior history of IE. Fifteen patients (45%) complained of fever, 21(64%)respiratory symptoms (cough, chest pain and/or dyspnea), 12(36%) had back or leg pain. CXR was consistent with SPE in 15(45%). In 18(55%) SPE were identified on CT [chest 17 (51%), abdomen, 1 (3%)]. Twenty-four patients (73%) had tricuspid vegetations, 1 (3%) tricuspid plus mitral, 1(3%) mitral only. Staphylococcus aureus was identified in 30(91%), 18 (55%) of which were methicillin-resistant (MRSA); Streptococcus, Enterococcus fecalis and S. hominis in 1(3%) each. Eleven patients (33%) required ICU admission, 7(21%) required mechanical ventilation, 7(21%) had septic shock requiring vasopressors. Four patients died (12%). Average length of hospital stay (LOS) was 23±13 days.
CONCLUSION: IE is a major health problem among IDU. SPE is common among these patients; some may not have typical respiratory symptoms or CXR findings. Those with SPE have high morbidity and complications requiring a prolonged LOS.
CLINICAL IMPLICATIONS: SPE, though common among IDU may not present with typical features of pulmonary infection and may be missed with CXR. A high degree of clinical suspicion is needed. These patients have a good prognosis but also have high morbidity and LOS. References.(1)Wolf AJ & O'Donnell A E Pulmonary effects of illicit drug useClin Chest Med 2004; 25 203–216.
DISCLOSURE: Jatinder Singh, No Financial Disclosure Information; No Product/Research Disclosure Information