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Endgames Spot Diagnosis

Fever in an intravenous drug user

BMJ 2016; 352 doi: (Published 01 March 2016) Cite this as: BMJ 2016;352:i1137
  1. Jennifer van Griethuysen, junior clinical fellow intensive care1,
  2. Simon W Dubrey, consultant cardiologist2
  1. 1King’s College Hospital NHS Foundation Trust, London, UK
  2. 2Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK
  1. Correspondence to: J van Griethuysen Jennifer.vangriethuysen04{at}

A 29 year old intravenous drug user presented to the acute medical unit feeling generally unwell. On clinical examination he was found to be in septic shock with a fever of 39.2°C. A septic screen was performed and broad spectrum antibiotics started empirically. Staphylococcus aureus was grown in both blood culture bottles after one day. An echocardiogram showed a large irregular mass on …

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