Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with persistent fever, chills, and pleuritic chest pain. History significant for IV drug use or presence of central venous catheter. Reports productive cough, occasionally hemoptysis, and dyspnea. No signs of systemic embolization to the CNS or peripheral vasculature.
Clinical Examination Findings
Vitals: Febrile, tachycardic, tachypneic. HEENT: No Roth spots or conjunctival petechiae. CV: Tricuspid regurgitation murmur (holosystolic, increases with inspiration) present. Lungs: Bilateral crackles or focal consolidation suggestive of septic pulmonary emboli. Skin: Janeway lesions or Osler nodes absent. Extremities: No peripheral edema or clubbing.
Treatment Protocol
Initiate empiric IV antibiotic therapy (e.g., Vancomycin) pending blood culture sensitivity results. Obtain serial blood cultures (3 sets). Perform transthoracic (TTE) followed by transesophageal echocardiogram (TEE) to assess vegetation size and valvular function. Consult Infectious Disease and Cardiothoracic Surgery for potential surgical intervention if vegetation >10mm or recurrent emboli occur.