A 33-year-old man comes to the emergency department due to 3 days of shortness of breath, profound fatigue, and chills. The patient has a history of intravenous drug use. He was enrolled in a methadone program but admits to relapsing last week. Temperature is 40 C (104 F), blood pressure is 75/40 mm Hg, pulse is 122/min and regular, and respirations are 40/min. He is admitted to the intensive care unit but dies despite treatment efforts. Lung autopsy findings are shown in the image below. Which of the following is the most likely diagnosis in this patient?

Question

A 33-year-old man comes to the emergency department due to 3 days of shortness of breath, profound fatigue, and chills.  The patient has a history of intravenous drug use.  He was enrolled in a methadone program but admits to relapsing last week.  Temperature is 40 C (104 F), blood pressure is 75/40 mm Hg, pulse is 122/min and regular, and respirations are 40/min.  He is admitted to the intensive care unit but dies despite treatment efforts.  Lung autopsy findings are shown in the image below.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Eductional Objective: Pulmonary infarcts are typically hemorrhagic (red) and wedge-shaped in the periphery of the lung.  Intravenous drug users are at increased risk of tricuspid valve endocarditis, which can cause multiple septic pulmonary infarcts due to embolization of tricuspid valve vegetation fragments.

A 33-Year-Old Man Comes to the Emergency Department Due to 3