Spontaneous pneumothorax as a complication of septic pulmonary embolism in an intravenous drug user: a case report.
Infective endocarditis has been the major cause of morbidity and mortality among intravenous drug users (IDUs) with infections, mostly involving the tricuspid valve and presenting multiple septic pulmonary embolisms. Numerous pulmonary complications of septic pulmonary embolism have been described, but only a few have reported spontaneous pneumothorax. Our patient, a 23-year-old heroin addict, was hospitalized for tricuspid endocarditis and septic pulmonary embolism. Acute onset of respiratory distress occurred on his seventh hospital day and rapidly resulted in hypoxemia. Immediate bedside chest radiograph demonstrated left pneumothorax. It was thought to be a spontaneous pneumothorax, because he had not undergone any invasive procedure before the occurrence of pneumothorax. His clinical condition improved after the insertion of an intercostal chest tube. He later underwent surgery to replace the tricuspid valve as a result of the large size of the vegetation and poor control of infection. He ultimately survived. Pneumothorax is a possible lethal complication of septic pulmonary embolism in IDUs with right-sided endocarditis and should be considered in such patients when respiratory distress occurs acutely during their hospitalization.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chau-Chyun
CC
Sheu
Jhi-Jhu
JJ
Hwang
Jong-Rung
JR
Tsai
Tung-Heng
TH
Wang
Inn-Wen
IW
Chong
Ming-Shyan
MS
Huang
D000328:Adult; D016470:Bacteremia / Q000150:complications*; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000209:etiology*; D011655:Pulmonary Embolism / Q000150:complications*; D013203:Staphylococcal Infections / Q000150:complications*; D015819:Substance Abuse, Intravenous / Q000150:complications*