Background: The opioid epidemic continues to exert a significant impact on our health care system. Patients with intravenous drug use (IVDU) often develop life threating infections leading to prolonged hospitalizations with poor outcomes. Traditionally, the focus of treatment during these hospitalizations is on the infectious complications with very little emphasis on the underlying substance use [...]

Case Presentation: A 30 year old man with a history of type 1 diabetes mellitus and bioprosthetic aortic valve replacement (AVR) for endocarditis presented with 2 days of left eye pain and vision loss associated with fevers, headache, and nausea. He reported intravenous drug use (IVDU) 4 days prior to admission after 14 months of [...]

Case Presentation: AS is 36-year-old woman with methamphetamine and opioid use disorder (OUD) hospitalized with endocarditis who is evaluated by the Addiction Consult Service (ACS), and started on sublingual Buprenorphine/naloxone (Bup/nx) for treatment of OUD. Urine drug screens continue to be inappropriately positive for methamphetamine inpatient. Extended Release Buprenorphine (Bup-XR) is discussed and with her [...]

Case Presentation: A 30-year-old G1P1 woman with a history of seasonal allergies, depression, and remote intravenous heroin use presented with progressively worsening bilateral hand swelling over the past three years since giving birth. She described painless bilateral hand swelling with nail thinning, skin bruising, decreased finger dexterity, and intermittent leakage of fluid. She did not [...]

Case Presentation: A 55-year-old woman with intravenous polysubstance abuse presented with a 1-week history of back pain, fever, and cough with blood-tinged sputum. Vital sign on admission showed tachycardia and hypotension but she responded well to fluid resuscitation. A pansystolic murmur grade 2 was noted. There was diffuse midline and paraspinal tenderness over the back. [...]

Case Presentation: A 21 year-old male with history of untreated Hepatitis C and intravenous drug use presented with acute right-sided weakness, fevers and altered mental status. Exam was significant for word-finding difficulty, asymmetric pupils, and 4/5 right-sided upper extremity and facial weakness. Labs were remarkable for leukocytosis. Brain MRI demonstrated expansile process involving the left [...]

Case Presentation: 29-year-old Hispanic male with history of intravenous drug use (IVDU) with fentanyl and methamphetamine, was brought to the hospital after being found confused on the streets. Patient was very cachectic, tachypneic and had track marks in the cubital fossa suggestive of IVDU. Patient was febrile with 100.6 F, had leukocytosis with WBC 18 [...]