LAUSR

A 33-year-old male with a history of atopic dermatitis, was admitted with a 6-week history of fever. Enhanced computed tomography revealed multiple emboli to the lungs and spleen and a psoas muscle abscess (Fig. 1A). Transthoracic echocardiography demonstrated a 3.5-cm mobile vegetation on the tricuspid valve and severe tricuspid regurgitation (Fig. 1B). Blood cultures grew out methicillin-sensitive staphylococcus aureus (MSSA). Despite IV antibiotic therapy with Cefazolin, his fevers continued and surgery was performed through a right anterior thoracotomy incision with femoral cannulation. A large vegetation was found on the anterior leaflet of the tricuspid valve along with an area of leaflet perforation. In addition, a 6.5-cm shaft of hair was extracted from trabeculations in the right ventricle (Fig. 2A). The anterior leaflet of the tricuspid valve was removed and the annulus was debrided. The tricuspid valve was replaced with a # 31-mm Epic bioprosthesis (St Jude Inc, St Paul, MN). The patient tolerated the procedure well. The Gram stain of the hair shaft showed Gram + cocci in clusters which ultimately grew out MSSA (Fig. 2B). The patient has been free of any recurrent infections 7 months following surgery.