Tricuspid Valve Infective Endocarditis with Severe Tricuspid Regurgitation

BACKGROUND Tricuspid valve infective endocarditis (TVIE) is a serious condition commonly associated with intravenous drug use (IVDU). It frequently leads to complications such as severe tricuspid regurgitation, septic embolization, and vegetation growth requiring surgical intervention. This case highlights the complexities of treating TVIE in an IVDU patient and emphasizes the need for multidisciplinary care strategies. CASE REPORT A man in his early 40s with a history of IVDU and hepatitis C presented with generalized chest pain, productive cough, fevers, and left groin swelling. Blood cultures confirmed methicillin-sensitive Staphylococcus aureus bacteremia, and echocardiography revealed a large (19 mm) vegetation on the tricuspid valve with severe tricuspid regurgitation and evidence of right ventricular overload. Despite an initial course of intravenous antibiotics, the patient exhibited poor adherence to treatment and discharged against medical advice. He returned with worsening symptoms, persistent bacteremia, and progressive vegetation growth, necessitating surgical intervention. However, due to concerns regarding postoperative compliance, compounded by the patient's fear of surgical risks and ongoing substance use, he refused surgery after initially consenting, resulting in loss to follow-up. CONCLUSIONS This case underscores the challenges of managing TVIE in the context of IVDU, particularly regarding treatment adherence and continuity of care. It highlights the importance of early multidisciplinary intervention, including addiction support services, supervised antimicrobial therapy, and patient-centered discharge planning. Future strategies should focus on integrating medical and social interventions to improve patient outcomes and reduce recurrent infections in this high-risk population.