Staphylococcal Tricuspid Endocarditis in Heroin Addicts

Abstract

Six patients with staphylococcal endocarditis secondary to heroin addiction are presented, bringing the total number of reported cases to 16. Septic pulmonary embolism dominated the clinical course in all patients. Transient murmurs of tricuspid insufficiency were heard in two patients. One other patient developed a loud murmur of tricuspid insufficiency along with other physical signs of this lesion. Cardiac findings in the remaining patients were non-specific or absent. Five of the six patients had episodes suggesting renal embolization; two patients had retinal emboli. Chest x-rays revealed numerous bilateral densities which in four patients progressed to cavitation. The cavities ultimately healed in all. A coagulase-positive, hemolytic Staphylococcus aureus was isolated from the blood in four patients. In the other two patients, S. aureus was isolated from the urine in both and from the sputum in one, but not from the blood. Only one patient died. Autopsy revealed multiple pulmonary and renal abscesses and, as in the four autopsied cases in the literature, endocarditis of the tricuspid valve. The similarity of the clinical features of those who survived to the patients coming to autopsy suggests the survivors also had tricuspid endocarditis. Staphylococcal tricuspid endocarditis appears to be a frequent and highly characteristic complication of heroin addiction. The reasons for the unique type and location of this infection are discussed.