He was given another course of IV vancomycin, gentamycin, clindamycin
and oral rifampicin. He failed to respond to the medical therapy and developed heart failure and septic shock. He underwent open heart vegetation excision (Figs. 5d&f), and died two days postoperation.
Patient 7 was a 31-year-old man who had been abusing Subutex and Dormicum for two years. He presented with an altered mental status.