Figure 2: T1 sagittal MRI L-spine. Red arrow at the L4-L5 level
demonstrates marked marrow signal changes suggestive of
osteomyelitis/discitis
Initial blood cultures returned positive for Abiotrophia defectiva. At
this time vancomycin was replaced with penicillin and gentamicin. There
was suspicion for left-sided endocarditis with sequelae from septic
emboli. Trans-thoracic Echocardiogram (TTE) revealed an ejection
fraction (EF) 55% with severe mitral regurgitation. Trans-esophageal
Echocardiogram (TEE) revealed EF 60-65%, with a probable mobile mass on
the aortic valve with undefined origins along with mild-to-moderate
aortic stenosis (Figure 3)