Infections in the immunocompromised: lessons from a fatal case report of tricuspid endocarditis in multiple sclerosis

Abstract Background Multiple sclerosis (MS), a chronic neurological disorder, is characterized by damage to the central nervous system, autoimmune processes, and deterioration of the myelin sheath, which lead to a variety of physical, cognitive, and emotional symptoms. Currently, a cure for MS does not exist, and treatments aim only to manage symptoms and enhance quality of life. Betaferon (interferon beta-1b), a disease-modifying therapy, is used to minimize the frequency of relapses and the progression of disability by altering immune responses. However, this therapeutic strategy also increases the risk of infectious diseases, such as tricuspid endocarditis, which is a severe infection of the heart valve that is often associated with chronic intravenous drug use and carries potential life-threatening consequences. Case presentation We present a case of a 48-year-old male who was undergoing Betaferon therapy for MS. He was admitted to the emergency room owing to fever, shortness of breath, and altered mental state. Physical examination revealed clinical signs of endocarditis, and laboratory results indicated severe thrombocytopenia, anemia, and elevated inflammatory markers. Imaging confirmed lung abnormalities and vegetations on the tricuspid valve. Blood cultures identified methicillin-sensitive Staphylococcus aureus . Intravenous antibiotics were initiated, and surgical intervention was planned. Despite initial antibiotic therapy improving his clinical and laboratory conditions, the patient experienced multiple pulmonary embolic events that led to death after 16 days of hospitalization. Conclusion This case underscores the challenges of identifying and managing endocarditis in immunocompromised patients and highlights the complexities of treating infections in individuals with chronic diseases.