Infectious endocarditis Quiz: Ace Your Exams
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A 28-year-old man presents to the emergency department with a 1-week history of fever, fatigue, and night sweats. He has not had a sore throat, cough, diarrhea, or weight loss. The patient has a history of intravenous drug use and admits to sharing needles. Temperature is 39.3°C (102.7°F), blood pressure is 107/71 mm Hg, pulse is 110/min, respiratory rate is 16/min, and oxygen saturation is 96% on room air. Physical examination reveals a grade 3/6 holosystolic murmur best heard at the lower left sternal border that radiates to the right lower sternal border. Reddish brown lesions are noted under the nail beds. Laboratory evaluation is significant for leukocytosis and an elevated CRP. ECG shows sinus tachycardia. Blood cultures are drawn and results are pending. A transesophageal echocardiogram shows vegetation on the tricuspid valve. Which of the following is the best next step in management?
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