Mitral valve endocarditis in an IV ethnobotanical drug user coinfected with HIV-HCV

Abstract

Case report We present the case of a young male, MMA, 30 years of age, iv ethnobotanical drug user since 2010 (ex-heroine user since 1994), who was admitted in our intensive care unit for stage III coma, recently installed after prolonged febrile syndrome at home (previously has refused hospitalization). His HIV and HCV tests were positive, chest x-ray was conclusive with staphylococcal bronchopneumonia, cardiac echography showed gigantic mitral valve vegetation and brain MRI showed multiple cerebral abscesses. Blood culture was positive for methicillin resistant Staphylococcus aureus, establishing diagnosis of sepsis with multiple system organ failure. He was intubated and received broad spectrum antibiotics for more than 3 months, as well as supportive therapy. He also receives tuberculostatic regimen (because of persistent fever and epidemiological risks) which was stopped when no bacteriological evidences for tuberculosis were obtained. Because immunological suppression was severe (initial CD4 count of 131 cells/mL), antiretroviral treatment with raltegravir and abacavir/lamivudine was given with appropriate psychological counseling. After slightly improvement patient presented sudden chest pain, aphasia and right hemiparesis due to septic emboli from the mitral vegetation. After recovered once again, nine months from the initial admission, having no evidences of active infection, patient underwent mitral valve replacement with good post operator recovery.