D-Dimer 10, Haptoglobin Nml, fibrinogen nml

Blood cx: +MSSA in 5 hours

CT: diffuse bilateral focal consolidations and cavitations

TTE: large TV vegetation

Outcome

MSSA tricuspid valve endocarditis with mild DIC - developed respiratory failure on HD2 requiring transfer to ICU.  Treated with 6 weeks of cefazolin.  No surgery performed due to concerns of causing additional embolization.  Developed RHF requiring diuresis.

Take Home Points

• Classic findings of septic pulmonary emboli (basilar predominant, subpleural wedges/nodules)
• Bactericidal abx for MSSA rather than vancomycin
• Limited surgical management for TVIE in IVDU , often non-surgical vs. valvulectomy