Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death

Abstract

Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded.

Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review

“…Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine per dose [ 1 , 2 ], widely used as a narcotic supplement in anesthesia and in the management of acute and severe chronic pain [ 3 ]. However, by virtue of its effectiveness and diffusion, fentanyl is experiencing an important upward trend also in the field of abuse, to the point of constituting, alongside the well-known classical opioids, a current and concrete problem of public order in many countries [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”