Investigations
Initial work up included a complete blood count which showed microcytic hypochromic anemia (7.1; normal 12-16 g/dL). The white blood cell and platelet counts were within normal limits. The patient had a positive COVID test on admission but her chest x-ray (Figure 1) did not show any consolidation or effusion. Blood cultures are positive with Enterococcus faecalis. In the setting of fever, positive blood cultures and heart murmur, an echocardiogram was done showing a new finding of 0.8 centimeter circular echo density on the ventricular surface of the pulmonary valve protruding into the right ventricle during diastole (Video 1) (Video 2). Serial cardiac troponin T (cTnT) was elevated at 0.541 ng/mL and at 0.595 ng/mL (normal < = 0.010 ng/mL).