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Right-sided infective endocarditis with septic pulmonary emboli — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesRight-sided infective endocarditis with septic pulmonary emboliSCE Acute Medicine

A 34-year-old man presents with fever, pleuritic chest pain and multiple tender nodules on his fingers. He injects heroin and has a systolic murmur at the left lower sternal edge. CT chest shows multiple peripheral cavitating nodules. What is the most likely diagnosis?

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Correct answer: C — Right-sided infective endocarditis with septic pulmonary emboli

Injection drug use, tricuspid-area murmur and cavitating peripheral lung nodules point to right-sided infective endocarditis with septic pulmonary emboli. TB can cavitate but does not explain the acute murmur and embolic pattern as well. Goodpasture syndrome would cause haemoptysis, renal findings and diffuse alveolar haemorrhage. Blood cultures before antibiotics and echocardiography are key early tests.

Reference: NICE NG195, ESC infective endocarditis guideline