Abstract
A 35-year-old woman presented with a 1-week history of fever and malaise. She was in an acutely ill state. An HIV screening test was negative. No heart murmurs were noted on auscultation. Computed tomography revealed multiple patchy nodules throughout both lungs, some with cavitation and infiltration. The nodules were randomly distributed throughout a background of multifocal consolidation; however, they favored the peripheral zones (Picture). Blood cultures were positive for Staphylococcus aureus. Transthoracic echocardiography demonstrated areas of vegetation involving the tricuspid valve. Patients with tricuspid valve infective endocarditis (IE) often do not have detectable heart murmurs (1). The patient later confessed that she was an injection drug user (IDU). Unlike in Western countries (2), right-sided endocarditis is rare in Japan, although the prevalence of IDUs is increasing. Japanese clinicians should consider right-sided IE even in patients without murmurs when septic pulmonary emboli with staphylococcemia are detected.
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