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Infective Endocarditis in an Intravenous Drug User: Clinical Challenges, Ethical Dilemmas, and Multidisciplinary
Munna Hazime1, Shailes Paudel2, Alexander A Restum1
1Medical Education, Wayne State University School of Medicine, Detroit, USA.
Cureus
|July 25, 2025
Summary
This case study details managing infective endocarditis (IE) in an intravenous drug user (IVDU) with HIV, highlighting complex clinical and ethical challenges. It stresses patient-centered care and respecting autonomy in critical illness.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Ethics
Background:
- Infective endocarditis (IE) is a severe heart infection, particularly prevalent in intravenous drug users (IVDU).
- Staphylococcus aureus is a primary pathogen, often affecting the tricuspid valve due to endothelial trauma and microbial colonization in IVDU.
Observation:
- A 48-year-old female IVDU presented with IE, septicemia, disseminated intravascular coagulation, septic emboli, and tricuspid valve disease.
- Comorbidities included newly diagnosed HIV, emotional distress, and chronic pain, complicating management.
Findings:
- Management involved tailored antibiotics, infectious disease consultation, and palliative care.
- Ethical dilemmas emerged regarding patient autonomy versus beneficence when the patient opted for hospice care.
Implications:
- The case underscores the need for prompt diagnosis and multidisciplinary collaboration in managing IE in high-risk populations.
- It emphasizes ethical sensitivity, compassionate communication, and patient-centered care, respecting autonomy in complex clinical scenarios.
Keywords:
cardiology researchinfective endocarditisintravenous drug usermulti-modality pain managementmultidisciplinary managementMore Related Videos
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