Diagnostic clues in metastatic lesions of endocarditis in addicts

Gram stains and cultures of multiple extravascular sites showed the infecting organisms in 17 of 26 heroin addicts with endocarditis. In addition to routine blood cultures, the etiologic agent was cultured from Osler nodes and Janeway lesions in ten patients, subcutaneous abscesses in eight, pleural fluids in eight, joint aspirates in three, spinal fluids in three, pericardial fluids in two, muscle abscesses in two and endometrium in one patient. Gram-positive cocci were found in extravascular lesions in 11 of 12 patients with staphy-lococcal endocarditis and from as many as four different sites. In contrast, no Gram-positive cocci were seen in extravascular sites in any of eight patients with enterococcal endocarditis although six of them had peripheral lesions. Gram stain and culture of multiple extravascular sites appears to provide a valuable early clue to the nature of the etiologic agent in addict endocarditis.