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BMJ Case Rep. 2010; 2010: bcr1020092404.
Published online Aug 24, 2010. doi:  10.1136/bcr.10.2009.2404
PMCID: PMC3027946
Unusual association of diseases/symptoms
Massive haemoptysis in an intravenous drug user with infective tricuspid valve endocarditis
Karin Anne Lydia Müller,1 Christine Stefanie Zürn,1 Htun Patrik,1 Martin Heuschmid,2 Jürgen Hetzel,3 Andreas Henning,1 Iris Irmgard Müller,1 Georg Lamprecht,4 Claus von Weyhern,5 Christian Herdeg,1 Gerhard Ziemer,6 Meinrad Paul Gawaz,1 and Tobias Walker6
1Kardiologie, Medizinische Klinik Universitaetsklinikum Tuebingen, Tuebingen, Germany
2Radiologische Universitätsklinik, Tuebingen, Germany
3Pulmologie, Medizinische Klinik, Tuebingen, Germany
4Gastroenterologie, Medizinische Klinik, Tuebingen, Germany
5Pathologisches Institut, Tuebingen, Germany
6Klinik für Herz-, Thorax-, Gefäßchirurgie, Tuebingen, Germany
Correspondence to Tobias Walker, tobias.walker/at/med.uni-tuebingen.de
Abstract
Major causes of morbidity in intravenous drug users are infections. In infective endocarditis, the tricuspid valve is mainly involved. Masses can cause septic embolisms and, in rare cases, they are associated with mycotic aneurysms of pulmonary arteries that lead to severe haemorrhage.
We report the case of a young woman with a history of intravenous drug abuse and prolonged infective tricuspid valve endocarditis. Initially, echocardiography showed large masses on the anterior leaflet of the tricuspid valve and severe tricuspid regurgitation; blood cultures revealed staphylococcus and streptococcus species. Eight months after initial diagnosis, she presented with severe haemoptysis and fever. CT revealed a ruptured mycotic aneurysm of the right pulmonary artery. Lobectomy was performed immediately.
Postoperatively, the patient fully recovered. After continued antibiotic treatment, follow-up examinations showed negative echocardiographic findings and blood cultures results.
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