Streptococcus pyogenes (Group A Strep) Quiz: Ace Your Exams

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A 30-year-old man comes to his primary care physician for evaluation of progressive fatigue and dyspnea for several months. He does not smoke, drink alcohol, or use illicit drugs. Family history is unremarkable. He traveled to South America one year ago but does not recall any subsequent illnesses. Temperature is 37.0 °C (98.6 °F), pulse is 75/min, and blood pressure is 131/80 mmHg. On physical examination, the patient appears visibly dyspneic. A systolic murmur is auscultated over the cardiac apex. Pulmonary auscultation reveals diffuse rales over both lung fields. The patient undergoes cardiac biopsy, with the findings demonstrated below. Which of the following is the most likely etiology of this patient's clinical condition?


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