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)