Fever in a 40-Year-Old Intravenous Drug User

John L. Brusch, MD


January 12, 2015

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions.


A 40-year-old male intravenous drug user is admitted to the hospital with a body temperature of 103.2°F. He strongly denies recent use of illicit drugs. He began using cocaine at 18 years of age. Within 1 year, he was no longer able to afford his habit. At that point, he switched to heroin.

Three years later, the patient was admitted to the acute care hospital for treatment of a deep-seated soft-tissue infection of his left arm that complicated a frequently used injection site. Treatment consisted of surgical debridement, as well as antibiotic coverage of mouth flora (anaerobic staphylococci and streptococci and Moraxella). His caregivers were surprised by this set of organisms. Upon questioning, he admitted that, as many addicts do, he would lick his injection needle for good luck.

Upon discharge, the patient resumed injecting heroin but did not continue to contaminate his needles. Ten years ago, he was treated for hepatitis C virus infection but did not respond. At that point, he stopped using heroin. He abstained from the drug for many years, until he lost his job, at which point he reverted to using heroin.

The patient smokes two packs of cigarettes daily. He abstains from alcohol. His medical history is otherwise unremarkable.


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