Decoding the signs: Multifaceted presentation of infective endocarditis in an intravenous drug user
Abstract
Infective endocarditis (IE) is a life-threatening infection resulting from the invasion of virulent microorganisms into the endocardial surface, often accompanied by significant morbidity and mortality if not promptly treated. We report a case of acute native valve IE in a patient with a history of intravenous drug use (IVDU). The patient presented with sudden-onset right-sided hemiparesis and altered mental status. Neuroimaging demonstrated an infarct in the left perisylvian cerebral cortex and insular region, corresponding to the left middle cerebral artery territory. Although the initial presentation resembled a typical stroke, clinical examination revealed a plethora of peripheral stigmata of IE, including Janeway lesions, Osler nodes, splinter hemorrhages, and Roth spots on fundoscopic evaluation. Abdominal imaging revealed multiple splenic and left renal infarcts. Transthoracic echocardiography identified mobile vegetations on the anterior and posterior mitral leaflets. Laboratory studies showed anemia, leukocytosis with neutrophilic predominance, and a markedly elevated C-reactive protein, while blood cultures remained negative. The patient was managed empirically with intravenous antibiotics, to which he responded: his fever resolved, sensorium improved, and he was discharged with residual right hemiparesis. This case underscores the diagnostic challenges in IE, especially in IVDU patients, and highlights the importance of early, aggressive management to reduce complications.
Related
- Prevalence, risk factors, and outcomes of infective endocarditis in people living with HIV: A systematic review and meta-analysis of intravenous drug use and microbiological profiles.
- Antibiotic Prophylaxis of Infective Endocarditis in Dentistry: An Update on the ESC, AHA, and NICE Guidelines
- Robotic tricuspid valve repair for infective endocarditis with leaflet perforation and severe tricuspid regurgitation
- Integrated Clinical, Biological, and Echocardiographic Factors Independently Associated With In-Hospital Mortality in Infective Endocarditis: A Single-Centre Cohort Study From Morocco
- Tricuspid Valve Infective Endocarditis Seen on Point-of-Care Ultrasound: A Case Report
BibTeX
@article{kumar2026decoding,
title = {{Decoding the signs: Multifaceted presentation of infective endocarditis in an intravenous drug user}},
author = {Vivek Kumar and Nidhi Bhardwaj and Ashish Jindal and Rayidi Rajesh},
journal = {Journal of Dr. NTR University of Health Sciences},
year = {2026},
month = jul,
doi = {10.4103/jdrntruhs.jdrntruhs_10_26},
url = {https://doi.org/10.4103/jdrntruhs.jdrntruhs_10_26},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Decoding the signs: Multifaceted presentation of infective endocarditis in an intravenous drug user
AU - Vivek Kumar
AU - Nidhi Bhardwaj
AU - Ashish Jindal
AU - Rayidi Rajesh
PY - 2026
DA - 2026/07/01
JO - Journal of Dr. NTR University of Health Sciences
DO - 10.4103/jdrntruhs.jdrntruhs_10_26
UR - https://doi.org/10.4103/jdrntruhs.jdrntruhs_10_26
AB - Infective endocarditis (IE) is a life-threatening infection resulting from the invasion of virulent microorganisms into the endocardial surface, often accompanied by significant morbidity and mortality if not promptly treated. We report a case of acute native valve IE in a patient with a history of intravenous drug use (IVDU). The patient presented with sudden-onset right-sided hemiparesis and altered mental status. Neuroimaging demonstrated an infarct in the left perisylvian cerebral cortex and insular region, corresponding to the left middle cerebral artery territory. Although the initial presentation resembled a typical stroke, clinical examination revealed a plethora of peripheral stigmata of IE, including Janeway lesions, Osler nodes, splinter hemorrhages, and Roth spots on fundoscopic evaluation. Abdominal imaging revealed multiple splenic and left renal infarcts. Transthoracic echocardiography identified mobile vegetations on the anterior and posterior mitral leaflets. Laboratory studies showed anemia, leukocytosis with neutrophilic predominance, and a markedly elevated C-reactive protein, while blood cultures remained negative. The patient was managed empirically with intravenous antibiotics, to which he responded: his fever resolved, sensorium improved, and he was discharged with residual right hemiparesis. This case underscores the diagnostic challenges in IE, especially in IVDU patients, and highlights the importance of early, aggressive management to reduce complications.
SN - 2278-1889
SN - 2277-8632
ER -