ABSTRACT
Infective endocarditis (IE), with its high morbidity and mortality, is a frequent complication of injection drug use (IDU). We present a case highlighting the complexities in the management of IDU-associated IE (IDU-IE) in a 46-year-old male with active IDU who presented with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and a large tricuspid valve vegetation. Urgent tricuspid valve surgery was indicated due to the size of the vegetation measuring up to 4 cm, along with recurrent pulmonary septic emboli. The patient underwent an uncomplicated and successful complete vegetectomy, tricuspid valve repair, and completed a 42-day antibiotic course. During the six-week follow-up, he showed complete recovery and maintained successful abstinence from illicit drug use, supported by an addiction medicine specialist. This case underscores the importance of early recognition, appropriate antibiotic therapy, and individualized surgical intervention in optimizing outcomes. Effective management of IE necessitates a multidisciplinary IE team, including addiction medicine specialists. Addressing the underlying substance use disorder (SUD) is crucial to reducing the risk of recurrent IE.
ABSTRACT
Flecainide toxicity is a rare but serious condition that can present with a wide range of clinical symptoms. We report the case of a 79-year-old female with paroxysmal atrial fibrillation on flecainide therapy who developed altered mental status, visual hallucinations, and bradycardia. Laboratory results revealed an acute kidney injury, which contributed to elevated flecainide levels. Discontinuation of flecainide led to a rapid resolution of symptoms and normalization of ECG findings. This case underscores the critical need for careful monitoring of renal function and potential drug interactions in patients receiving flecainide to prevent toxicity, highlighting the wide range of flecainide toxicity, including rare manifestations such as encephalopathy and visual hallucinations.