Massive Pulmonary Embolism Revealing Right-sided Infective Endocarditis Complicated by Intracerebral Hemorrhage in a Non-IV Drug User

Abstract

Background: Right-sided infective endocarditis (RSIE) is typically associated with intravenous drug use or indwelling catheters. Its diagnosis in non-IV drug users is often delayed due to low clinical suspicion. The disease is often under-recognized in patients with atypical risk profiles, leading to delayed management and potentially severe complications. Case Presentation: We report a rare case of massive pulmonary embolism (PE) revealing tricuspid valve infective endocarditis in a 53-year-old woman with no history of intravenous drug use. The clinical course was complicated by intracerebral hemorrhage (ICH), resulting in death within five days. Despite early initiation of antibiotic therapy, the rapid progression of multi-organ failure and neurological deterioration precluded surgical intervention. Conclusion: This case underscores the importance of considering RSIE in patients without classical risk factors, particularly when septic pulmonary embolism and neurological complications are present. Clinicians should maintain a high index of suspicion and promptly perform echocardiography in atypical cases to avoid delayed diagnosis. Multimodal imaging and interdisciplinary management are crucial for optimal outcomes.