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Infective endocarditis (IE) is one of the cardiac inflammation diseases with high mortality and morbidity mainly affects the inner liner of the endocardium and the valves. The majority of the infective endocarditis is caused by infectious agents [1]. The incidence of IE is around 2-10/1 and increases in elders up to 20/1 per year [1]. I.V drug abusers are more likely to have IE usually caused by single agent and mostly affect Tricuspid valve. Polymicrobial IE is more rare and associated with high mortality up to 30% [2]. Addicted persons to heroin, cocaine, fentanyl and prescription opioids (Oxycodone, Morphine, and Hydrocodone) are more likely to have IE [3]. Here in our case, we had a patient with IE associated with multiple cerebral hemorrhagic and infarct areas, brain abscess, pleural effusion, ARDS (Acute respiratory distress syndrome) and bicytopenia, with history of one attack pancreatitis and addiction to fentanyl and alcohol. When medical treatment becomes insufficient, surgery should take place in the management, but the question is when to take the decision of surgery and what type of valves should be implanted. In this case we preferred to use bioprosthetic valve due to the patient’s characteristics and co-morbidities.

international archives of cardiovascular diseases

A Case of Acute Aortic Failure and Cerebral Infarcts due to Infective Endocarditis in a Patient Addict to Fentanyl and Alcohol-Management and Treatment