Polymicrobial endocarditis in intravenous heroin and fentanyl abuse

Infective endocarditis is a life threatening condition with a high mortality rate. Intravenous Drug Abusers (IVDA) are more likely to acquire endocarditis. Most of the cases of infective endocarditis are caused by a single pathogen; cases of polymicrobial endocarditis are rare and they are associated with a reported mortality rate of more than 30%. Only 21 cases of N. sicca endocarditis have been described in the literature since 1918, and only 15 reported cases of endocarditis which involved Actinomyces species have been reported since 1939. We are reporting a case of a 49-year-old male with intravenous heroin and fentanyl abuse, who presented with infective endocarditis caused by Neisseria sicca/subflava(N. sicca), Actinomyces, Streptococcus mitis, and Haemophilus parainfluenzae, complicated by septic emboli to the lungs and skin, ARDS , splenic infarct and immunocomplex mediated proliferative glomerulonephritis.