A 62-Year-Old Man With Tricuspid Valve Endocarditis, Bacteremia, and Septic Pulmonary Embolism Following Long-Needle Acupuncture.

BACKGROUND Acupuncture can pose a risk for both local and metastatic infections, particularly when performed under poor sterilization conditions. To date, a few cases of acupuncture-associated infective endocarditis (IE) have been reported, with most involving left-sided prosthetic or rheumatic cardiac valves. Right-sided endocarditis (RIE) induced by acupuncture is exceptionally rare. Here, we present a case of tricuspid valve IE and septic pulmonary embolism caused by acupuncture without traditional risk factors. CASE REPORT We describe a 62-year-old immunocompetent man with a 3-day history of fever, anorexia, and fatigue following long-needle acupuncture treatment. Initial antibiotic treatment with cefazolin successfully treated methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and resolved septic shock. However, on hospital day 10, new-onset tricuspid valve IE caused recurrent fever, dyspnea, hypotension, and sinus tachycardia. Disseminated abscesses involved in the bilateral psoas, iliopsoas, and erector spinae muscles, along with destruction of the L3/L4 vertebrae, indicated a clinical failure of cefazolin monotherapy. After switching to daptomycin for 6 days, emerging septic pulmonary embolism highlighted the limitation of daptomycin distribution in the lung. A sequential 5-day combination therapy of cefazolin and daptomycin was administered to address these complications. Cefazolin monotherapy was continued for 6 weeks, until the infection resolved. CONCLUSIONS Acupuncture can lead to severe infections, including RIE, in individuals without traditional risk factors. Due to the failure of monotherapy with initial cefazolin and later daptomycin, this case report highlights the importance of diagnosis and antibiotic options in MSSA RIE complicated by persistent bacteremia in non-IV drug users with a native valve.