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Right-sided infective endocarditis with septic pulmonary emboli — RCPSC EM MCQ

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HardInfectious disease emergenciesRight-sided infective endocarditis with septic pulmonary emboliRCPSC EM

A 37-year-old who injects drugs has fever, pleuritic pain, haemoptysis, peripheral cavitating lung nodules and a new tricuspid regurgitation murmur. She is haemodynamically stable. What is the most appropriate initial diagnostic sequence?

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Correct answer: D — Draw three blood-culture sets before antibiotics and arrange urgent echocardiography

The best answer is “Draw three blood-culture sets before antibiotics and arrange urgent echocardiography”. This is highly suggestive of right-sided infective endocarditis with septic pulmonary emboli. In a stable patient, obtain three blood-culture sets from separate venepuncture sites before antimicrobial therapy when feasible, then obtain urgent echocardiography and admit with specialist involvement. Sputum culture, bronchoscopy and V/Q imaging do not establish the bacteraemic cardiac source; giving antibiotics first can reduce culture yield.

Reference: Emergency Care BC: Endocarditis—Diagnosis and Treatment: https://emergencycarebc.ca/clinical_resource/clinical-summary/endocarditis-diagnosis-and-treatment/