Diagnostic Dilemma| Volume 131, ISSUE 8, P913-915, August 2018

Breaking Away: Superior Mesenteric Artery Embolus

      The patient had 2 bouts of endocarditis in a short period, each instigated by a different organism, but the second had a most unusual herald. A 38-year-old man with fever and abdominal pain was brought to the Emergency Department from a subacute rehabilitation facility. Three months earlier, he had been admitted to the hospital and diagnosed with Granulicatella species bacteremia secondary to injection drug use and complicated by aortic valve endocarditis, splenic infarct, and a splenic artery aneurysm. He underwent splenectomy and aortic valve replacement with a bioprosthetic valve and was discharged with a peripherally inserted central catheter line to complete 6 weeks of treatment with intravenous penicillin G and gentamicin.
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