A 40-year-old man with a long history of intravenous drug addiction

A 40-year-old man with a long history of intravenous drug addiction presents to the emergency room complaining of fever, anorexia, malaise, shortness of breath, cough and chest pain for 2 days. On physical examination, temperature is 102.7 F, Pulse is 110/min. and blood pressure is 110/66. Irregular erythematous nodules are seen on his hands and feet.

Which of the following is most likely valvular lesion associated with this infection?

  • A – Mitral valve stenosis
  • B – Mitral valve regurgitation
  • C – Tricuspid valve regurgitation
  • D – Aortic valve stenosis
  • E – Pulmonic valve stenosis

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This patient most likely has infective endocarditis, a common complication of intravenous drug addiction. It is caused by staphylococcus infection due to multiple uses of same injection by addicts. Tricuspid regurgitation is the most common valvular lesion related to staph infection. It is characterized by pansystolic murmur, high pitched and loudest in the 4th intercostal space in the parasternal region. Mitral valve involvement is more likely related to subacute bacterial endocarditis which is mainly caused by streptococcal infection.

The correct answer is C

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