A Mitis Partis

A 44 Hispanic male with history of hyperlipidemia, intravenous drug use in remission, seeks care for fever and generalized malaise for the past week in the emergency department. He last used intravenous heroine about 4 months ago. He notes intermittent fevers and weight loss. On cardiac examination, he has a murmur at the second right intercostal space. A transthoracic echocardiogram reveals a structurally normal mitral valve without stenosis or regurgitation, however with premature closure of the mitral valve due to severe aortic regurgitation. There are also echo densities with independent mobility on the aortic valve representing vegetations that is confirmed with a transesophageal echocardiogram. CT imaging of the brain reveals no ischemic lesions.