Development of Mural Infective Endocarditis Following Paraspinal Abscess Drainage

A 38-year-old man with a history of a recently drained back abscess presented with progressive fatigue and myalgias in the setting of bacteremia. Echocardiography demonstrated a large, highly mobile aortic valve vegetation that could be seen migrating from the left ventricular outflow tract into the aortic root. Intraoperative assessment yielded a normal, trileaflet aortic valve without any evidence of endocarditis. In contrast, a large vegetation adhered to the ventricular septum and a moderately sized vegetation were noted on the papillary muscle, consistent with a rare presentation of mural endocarditis.