Managing Recurrent Endocarditis in Substance Use Disorder: The Role of Civil Commitment and Comprehensive Care

BACKGROUND The incidence of drug-induced infectious endocarditis is rapidly rising in the United States. Healthcare providers face different challenges in the management of infectious endocarditis in persons who inject drugs, including addiction relapse, non-compliance with treatment, and the associ...

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Bibliographic Details
Published in:The American journal of case reports 2025-01, Vol.26, p.e945940
Main Authors: Drvar, Thomas B, Shychuck, Emma M, Chhor, Behroz, Mayle, Lauren, Marshalek, Patrick, Zheng, Wanhong
Format: Article
Language:English
Subjects:
Adult
Endocarditis - therapy
Endocarditis, Bacterial
Female
Humans
Opioid-Related Disorders
Recurrence
Substance Abuse, Intravenous - complications
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Summary:BACKGROUND The incidence of drug-induced infectious endocarditis is rapidly rising in the United States. Healthcare providers face different challenges in the management of infectious endocarditis in persons who inject drugs, including addiction relapse, non-compliance with treatment, and the associated social stigma. These factors collectively complicate the management of drug-induced endocarditis, requiring comprehensive strategies that address both the medical condition and the underlying substance use disorder, as well as socio-behavioral aspects of patient care. CASE REPORT We present a case of a 33-year-old woman diagnosed with opioid use disorder and a history of tricuspid valve replacement who was transferred from a local emergency room to a general hospital for septic shock secondary to recurrent drug-induced infectious endocarditis. Psychiatry was consulted on day 13 of the admission after the patient was deemed, "not to be a surgical candidate" for second cardiac valve surgery because of a history of non-compliance and a high risk of drug relapse. Throughout her 4-month inpatient hospitalization, she received multiple forms of voluntary and involuntary treatment. The psychiatry consultation/liaison service played a significant role in the patient's care. She successfully engaged in multiple modalities of treatment that led to undergoing a second heart valve surgery. CONCLUSIONS This case highlights the importance of a multidisciplinary approach in management of infectious endocarditis in persons who inject drugs. The use of a civil commitment can allow for the provision of substance use disorder treatment and optimal medical care to an individual who may have lost hope and have temporarily impaired mental faculties.
ISSN:1941-5923
1941-5923
DOI:10.12659/AJCR.945940