Pharyngitis Workup Leads to the Discovery of Massive Tricuspid Vegetation

Infective endocarditis (IE) is one of the leading causes of life-threatening infections and is most often observed among patients who use intravenous (IV) drugs. We discuss the unique presentation of a 31-year-old gentleman with a two-week history of sore throat and shortness of breath, who returned to his community emergency room with persistent symptoms of streptococcal pharyngitis. A thorough history, physical examination, and diagnostic workup were conducted, where a large, protruding, highly mobile vegetation was observed on echocardiogram. His blood cultures grew methicillin-resistant Staphylococcus aureus. A vegetation measuring over 5 cm was surgically removed from his tricuspid valve. Following the operation, he underwent six weeks of extensive in-patient medical management with IV antibiotics to treat IE. This patient made a complete recovery and has since returned home.