Staphylococcus epidermidis Quiz: Ace Your Exams

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A 67-year-old man presents to the cardiologist with a several week history of fatigue, shortness of breath, fever, and chills. The patient underwent catheter-directed ablation for medication resistant atrial fibrillation six days ago. He additionally reports he recently underwent a root canal procedure several weeks ago. Past medical history is significant for rheumatic heart disease, mitral valve prolapse, mitral valve repair, and atrial fibrillation. Temperature is 38.1°C (100.6 °F), pulse is 105/min, respirations are 22/min, blood pressure is 122/63 mmHg, and oxygen saturation is 95% on room air. Physical examination demonstrates a holosystolic murmur heard at the cardiac apex. A surgical incision site over the patient’s left neck shows no erythema, discharge, or swelling. Laboratory findings are demonstrated below:  
 
Laboratory value  Result 
 Serum 
 Hemoglobin  13.5 g/dL 
 Hematocrit  40.5% 
 Leukocyte count  14,100/mm3 
 Platelet count  400,000/mm3 
 ESR                    34 mm/hr 
 CRP  6 mg/L 
Microbiology 
Blood cultures  Gram-positive, coagulase-negative bacteria in 3 consecutive plates  
 Which of the following is the most commonly affected structure in this disease process?  

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