An Unusual Case of Peritonitis in an Intravenous Drug User

Question: A 24-year-old man was admitted complaining of acute abdominal pain of 48 hours' duration. He also described chills, rigors, and extreme nausea. He had no significant past medical history other than active intravenous drug use. He recalled injecting heroin in his groin 48 hours before admission. He denied having ever smoked the drug. He was fully conscious, had a pulse of 138 beats per minute, blood pressure of 95/64, and temperature of 37.7°C. Positive abdominal findings were marked peritonitis and rigidity.